Panel urges lower cutoff for child lead poisoning

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In this Thursday, Feb. 23, 2006 photo, contractors Luis Benitez, foreground, and Jose Diaz, background, clean up lead paint in a contaminated building in Providence, R.I. A federal panel recommended Wednesday, Jan. 4, 2012 that the threshold for lead poisoning in children should be lowered. If adopted by government officials, hundreds of thousands of additional U.S. children could be classified as having lead poisoning. Recent research persuaded panel members that children could suffer harm from concentrations of lead lower than the old standard, Centers for Disease Control and Prevention officials said. (AP Photo/Chitose Suzuki) In this Thursday, Feb. 23, 2006 photo, contractors Luis Benitez, foreground, and Jose Diaz, background, clean up lead paint in a contaminated building in Providence, R.I. A federal panel recommended Wednesday, Jan. 4, 2012 that the threshold for lead poisoning in children should be lowered. If adopted by government officials, hundreds of thousands of additional U.S. children could be classified as having lead poisoning. Recent research persuaded panel members that children could suffer harm from concentrations of lead lower than the old standard, Centers for Disease Control and Prevention officials said. (AP Photo/Chitose Suzuki)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); ATLANTA (AP) — For the first time in 20 years, a federal panel is urging the government to lower the threshold for lead poisoning in children.

If adopted, hundreds of thousands more children could be diagnosed with lead poisoning. Too much lead is harmful to developing brains and can mean a lower IQ.

Recent research persuaded panel members that children could be harmed from lead levels in their blood that are lower than the current standard, officials at the Centers for Disease Control and Prevention said.

While the number of cases has been falling, health officials think as many as 250,000 children have the problem, many of those undiagnosed. The proposed change could take it to 450,000 cases.

Wednesday's vote by the Advisory Committee on Childhood Lead Poisoning Prevention would lower the definition of lead poisoning for young children from 10 micrograms of lead per deciliter of blood to 5 micrograms. The CDC has accepted all of the panel's recommendations in the past.

Lead — a metal that for years was common in paint and gasoline — can harm a child's brain, kidneys and other organs. High levels in the blood can cause coma, convulsions and death. Lower levels can reduce intelligence, impair hearing and behavior and cause other problems.

Usually, the victims are children living in old homes that are dilapidated or under renovation, who pick up paint chips or dust and put it in their mouths. Lead has been banned in paint since 1978. Children have also picked up lead poisoning from soil contaminated by old leaded gasoline, and from dust tracked in from industrial worksites.

Lead poisoning is detected through a blood test, often when kids are toddlers. Most cases are handled by seeking out and removing the lead source, and monitoring the children to make sure lead levels stay down. A special treatment to remove lead and other heavy metals is used for very high levels.

But the problem has seemed to be diminishing, based on the old standard. In 2009, researchers reported that 1.4 percent of young children had elevated lead levels in their blood in 2004, the latest data available. That compares with almost 9 percent in 1988.

The lead poisoning threshold was last changed in 1991. The proposed level of 5 micrograms was calculated from the highest lead levels seen in a comprehensive annual U.S. health survey. The panel recommended that it be reassessed every four years.

"It's a moving target," said Perry Gottesfeld, co-chair of the group that came up with the advice.

Some groups celebrated the decision, saying medical evidence has been mounting that lower levels of lead poisoning can erode a child's ability to learn and cause behavior problems.

"This is long overdue," said Ruth Ann Norton, executive director of the Coalition to End Childhood Lead Poisoning, a Baltimore-based organization.

The recommendation might be difficult to implement. In many places, it's up to city and county health departments to provide many of the services for lead poisoned kids, and those departments have lost more than 34,000 jobs in the last three years because of budget cuts. Meanwhile, Congress just slashed the CDC's lead program from more than $30 million to $2 million.

"The CDC should accept the recommendation," said Robert Pestronk, executive director of the National Association of County and City Health Officials.

"(But) the grim reality is that local health departments and other community agencies don't have the person-power to identify and follow up on all these children," he said.

The panel's Gottesfeld acknowledged the challenge the new recommendations may pose.

"It's certainly going to put a great strain on local departments," he said.

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CDC: http://www.cdc.gov/nceh/lead/

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Your home's age important for child lead exposure

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FILE - In this Thursday, Feb. 23, 2006 file photo, contractors clean up lead paint at a contaminated building in Providence, R.I. The risk of lead-based paint from older homes is back in the news, as the U.S. government considers tightening the definition of lead poisoning in babies, toddlers and preschoolers. Lower levels than previously thought may harm their developing brains. (AP Photo/Chitose Suzuki, File) FILE - In this Thursday, Feb. 23, 2006 file photo, contractors clean up lead paint at a contaminated building in Providence, R.I. The risk of lead-based paint from older homes is back in the news, as the U.S. government considers tightening the definition of lead poisoning in babies, toddlers and preschoolers. Lower levels than previously thought may harm their developing brains. (AP Photo/Chitose Suzuki, File)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); WASHINGTON (AP) — If you've been putting off repairing a peeling windowsill, or you're thinking of knocking out a wall, listen up: Check how old your house is. You may need to take steps to protect your kids from dangerous lead.

The risk of lead-based paint from older homes is back in the news, as the government considers tightening the definition of lead poisoning in babies, toddlers and preschoolers. Lower levels than previously thought may harm their developing brains.

That's a scary-sounding message. But from a practical standpoint, it's not clear how much would change if the government follows that advice. Already there's been a big drop in childhood lead poisoning in the U.S. over the past few decades. Public health programs have targeted the youngsters most at risk — poor children living in crumbling housing, mostly in cities — to try to get them tested and their homes cleaned up.

But specialists say it can be a risk in more affluent areas, too, as do-it-yourselfers embark on fix-ups without knowing anything about an environmental hazard that long ago faded from the headlines.

The main value of the proposed change may be in increasing awareness of how to avoid lead in everyday life.

"What we need to do is prevent the exposure in the first place," said Dr. Nicholas Newman, who directs the environmental health and lead clinic at Cincinnati Children's Hospital.

There are lots of ways people can be exposed to lead: Soil polluted from the leaded gasoline of yesteryear. Old plumbing with lead solder. Improperly using lead-glazed pottery or leaded crystal with food. Certain jobs that expose workers to the metal. Hobbies like refinishing old painted furniture.

Sometimes even imported toys or children's jewelry can have illegal lead levels, prompting recalls if they're caught on the U.S. market.

But the main way that U.S. children are exposed is from layers of old paint in buildings built before 1978, when lead was banned from residential paint.

Sure, the walls might have been painted over recently, and there may be no obvious paint chips to attract a tot crawling around on the floor. But friction from opening and closing windows and doors allows tiny leaded particles to make their way into household dust — and youngsters then get it on their hands that go into their mouths, explained Dr. John Rosen, a lead poisoning specialist at the Children's Hospital at Montefiore in New York City.

Very high lead levels can cause coma, convulsions, even death, fortunately a rarity today. But lower levels, especially in children under 6, can harm a child's brain, can reduce IQ and cause other learning, attention and behavioral problems — without any obvious symptoms to alert the parent.

How much is too much? Until now, the definition of lead poisoning in young children was 10 micrograms of lead per deciliter of blood. But in a draft report last fall, the National Toxicology Program analyzed recent scientific research to conclude there's good evidence that levels lower than 10 are a risk. Now advisers to the Centers for Disease Control and Prevention are urging that agency to lower the definition to 5 micrograms for now, periodically reassessing.

If the CDC agrees, its advisers estimated that could classify about 450,000 children with lead poisoning, up from roughly 250,000 today.

At these levels, there's no treatment for the child other than to end the ongoing exposure — clean up the house, Newman stressed. That's why prevention is so important. And while the youngest children are the most vulnerable, lead's not good for anyone's brain, so he advises taking common-sense precautions before potential exposures like renovating an old home.

What should families do? Here's advice from the Environmental Protection Agency and public health agencies:

—Check the age of your house. At checkups for babies through age 5, pediatricians are supposed to ask if you live in a home built before 1960, or one built before 1978 that's recently undergone renovation. The answers help guide who may need a blood test to check lead levels. Some states require testing of toddlers on Medicaid.

—Wash kids' hands before they eat, good advice no matter where you live or how old your house.

—Clean up paint chips immediately, and regularly wash toys that tots put in their mouths.

—Regularly wash windowsills and floors where paint dust can collect.

—If you're planning repairs or renovation in an old building, use lead-certified contractors who must follow EPA rules to minimize exposure from the work and can perform quality tests to see if your old paint really contains lead.

—If you rent and have peeling paint, notify your landlord. Many cities and states have lead-abatement rules, and programs to contact for help.

—Aside from paint, take off shoes at the door, to minimize tracking in lead-tainted soil.

—Use only cold water for drinking, cooking and making baby formula, and run it for 15 to 30 seconds. Hot tap water can pick up more lead from older plumbing than cold water.

___

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EPA lead information: http://www.epa.gov/lead/pubs/leadinfo.htm#hazard

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Similar punishments for adult, child homicide

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By Genevra Pittman

NEW YORK | Mon Oct 3, 2011 4:21pm EDT

NEW YORK (Reuters Health) - People suspected of child abuse homicide are just as likely to get convicted, and have similar sentences, as those who are arrested for killing an adult, according to a new study from Utah.

There have been questions about how courts rule on cases involving violence against children compared to violence against adults, with some studies suggesting that suspects of child abuse aren't as likely to be found guilty or aren't penalized as severely. But that was not the case here, say the authors.

"The most important thing we can do is prevent child abuse... and in the end prevent this from ever happening," said Dr. Hilary Hewes from the University of Utah, who worked on the study.

Still, "I thought it was very reassuring that we value children's lives and we take it seriously when they're lost," she told Reuters Health.

Child abuse homicide is defined as a guardian acting or failing to act in a way that results in a child's death, but doesn't count as aggravated murder. In this study, the definition included abusive head and stomach trauma, as well as asphyxiation and burning.

Using a statewide database of violent crimes, Hewes and her colleagues found 334 cases of adult and child non-justifiable homicide between 2002 and 2007.

That included a total of 66 child homicides, 34 of which were categorized as child abuse homicide, were under Utah's jurisdiction and had suspects that were alive to be prosecuted. Out of all adult crimes, 135 suspects were identified.

Both adult and child offenders were convicted at a similar rate -- 83 percent and 88 percent, respectively. In addition, both groups of suspects were just as likely to receive the highest types of conviction, a capital crime or felony 1, or to get a sentence that included the possibility of life in prison.

The researchers wrote in the Archives of Pediatrics and Adolescent Medicine that the results may not apply to other states, especially places where more youth deaths happen as a result of gang violence, or where medical examiners aren't as thorough about determining cause of death in childhood victims.

But for child abuse crimes in particular, the similar rates of conviction and severity of sentencing show that courts were not being easier on suspects in child cases, despite some beliefs that those crimes "lack intentionality" compared to people who kill adults.

"I think there is a different perception between crimes against children versus crimes against adults because of the huge age difference between the victims," said Wendy Walsh, from the Crimes Against Children Research Center at the University of New Hampshire, who wasn't involved in the new study.

Walsh was part of a study that found that in the 1980s and 1990s, child abuse cases were less likely to lead to charges being filed once they went to the prosecutor.

But in this case, she told Reuters Health, "I'm not surprised they did find these similar results, given the extremely aggressive, violent nature of these crimes."

SOURCE: bit.ly/oPnFuO Archives of Pediatrics and Adolescent Medicine, online October 3, 2011.

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Child health 'contrast' concerns

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2 October 2011 Last updated at 10:54 GMT 'Prioritisation of community child health services is vital,' says Andrew Jones, public health official The contrast between the health of babies born in poor and more affluent areas of north Wales has been branded as "unacceptable" by a public health chief.

A report from Betsi Cadwaladr University Health Board (BCUHB) shows people born in deprived parts of Rhyl can expect to die seven years earlier than those in areas like nearby Conwy.

It also shows a "stark" variation in the number of babies born with low birth weights, linked to poverty.

The report author is calling for action to end the "health inequalities" to create a "fairer society".

Rates of stillbirth, admissions to neonatal units, infant and child mortality, injuries and teenage pregnancy are higher in areas with high levels of deprivation, according to Andrew Jones.

He is the executive director of public health for Betsi Cadwaladr University Health Board (BCUHB) which manages the region's health services.

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Giving every child the best start in life is the highest priority. This is the key to reducing health inequalities and creating a fairer society.”

End Quote Andrew Jones Executive director of public health for Betsi Cadwaladr University Health Board He says the annual report focuses on the early years because scientific evidence shows influencing the development of children to maximise their health is most effective when done as early as possible.

'Vital'

"There is also a strong economic case as return on investment in the early years is higher than at any other stage," he says.

Mr Jones says current financial challenges highlight the importance of using resources wisely.

"Whilst there is a risk that we may wish to focus on the short term, the simple fact is that we cannot afford to ignore the evidence and the opportunity to improve health outcomes now and into the future," he said.

His report highlights 11 key areas to reduce the "inequity" across the region.

These include:

More support for vulnerable familiesReduce smoking in pregnancyReduce maternal obesity.

While the percentage of babies born with low birth weight in north Wales is slightly lower (5.5%) than the average for Wales (5.8%), the report says there is "considerable variation" across the region and a "stark geographical variation".

The highest percentage of low birth weights in north Wales is in Rhyl south west in Denbighshire, at 8.2%, compared to the lowest, 2.9%, found in Llandrillo yn Rhos, Conwy.

"Giving every child the best start in life is the highest priority," says Mr Jones.

"This is the key to reducing health inequalities and creating a fairer society. Prioritisation of community child health services is vital."

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Analysis: The debate over closing child heart surgery units

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27 September 2011 Last updated at 11:17 GMT By Jane Hughes Health correspondent, BBC News Nicolas Tompkins had surgery at 2.5 weeks Nicolas Tompkins' parents believe he wouldn't be with them if it wasn't for the doctors and nurses at the Royal Brompton Hospital in central London.

At just four weeks old, he's recovering from a 15-hour operation to correct a complicated and rare defect in his heart.

Surgeons effectively had to re-wire it, after discovering that his lungs weren't properly connected, and he wasn't getting enough oxygen.

He was lucky to be treated by a world expert in his condition.

His parents are incredulous at the thought that the team which saved his life could be about to be broken up.

"Everybody we meet here, every doctor, every nurse, is clearly at the top of their game," said his father, Andrew Tompkins. "There's nowhere like this in the world. How could they want to close it?"

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If we get centres of excellence, we can save money and still get better care”

End Quote Mike Farrar NHS Confederation Chief Executive The reason is that children's heart surgery across England is being reorganised. And, as one of three hospitals in London carrying out this kind of specialised paediatric treatment, the Royal Brompton was told it would have to scale down its children's heart unit and stop doing all operations.

Other units in Leeds, Southampton, Newcastle and Leicester are still waiting for a decision as to whether they will also stop doing operations. Ultimately, at least four will close across England.

The review does not affect patients in Scotland, who are all treated in Glasgow. Welsh patients are treated in England, while patients in Northern Ireland travel to Dublin for treatment.

Bristol scandal

The review of children's heart surgery came about as a result of the inquiry into the Bristol heart babies scandal in the 1990s, when a number of babies died needlessly during operations by surgeons with insufficient experience. It concluded that children would get better, safer care if there were fewer, larger, more specialised units.

"We know the best results can only be achieved by surgeons and units treating a lot of patients," said Professor Norman Williams, President of the Royal College of Surgeons. "And we also know that patients benefit from units with enough surgeons to give a round-the-clock service."

Yet, as the Royal Brompton's experience shows, reorganising services is not straightforward.

Without cardiac patients, it says its paediatric intensive care unit would no longer be viable. And without intensive care, it would no longer be able to offer its specialist children's lung services - treating children with cystic fibrosis and other conditions. It says its respiratory unit is second to none in the country, and many, many patients will lose out.

And so one part of the NHS is going head-to-head against another in the High Court. Watching around the country are not just the other units under threat, but NHS hospital trusts which know they must reorganise other hospital services to remain viable and provide the best possible patient care.

Tough challenge

The NHS Confederation has said the reconfiguration process will become increasingly necessary; not just because of a tougher financial climate, but also to improve care.

"At the moment, we're not getting the best outcomes we can because some services are distributed across too many sites," said NHS Confederation Chief Executive, Mike Farrar. "If we get centres of excellence, we can save money and still get better care."

Reorganising services is one of the hardest things the health service has to do, said Chris Ham, head of the health thinktank, the Kings Fund.

"But it is absolutely necessary at the present time," he said. "Not first and foremost because of the financial pressures but because we will only deliver world class standards of care if we grasp this nettle and take decisions that are long overdue by concentrating some of those services in fewer hospitals."

The fight over the future of the Royal Brompton may well be one of many more to come.

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Court hears child heart unit row

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27 September 2011 Last updated at 09:49 GMT The hospital has described the consultation as unlawful The Royal Brompton Hospital is starting a legal challenge over what it says was "deeply flawed" consultation which it claims has led to its children's heart surgery unit facing closure.

It says the shutting down of the unit would put the viability of the whole hospital at risk.

The hospital in Chelsea, west London, has the largest specialist heart and lung centre in the UK.

A judicial review over the consultation begins later at the High Court.

Its challenge, which is expected to be heard over three days, is against the consultation process launched by the Joint Committee of the Primary Care Trusts of England as part of a national review aimed at streamlining paediatric congenital cardiac surgery services (PCCS) around the country.

It is believed this is the first legal challenge of its kind to be brought by one NHS body against another.

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Our decision to take legal action has been taken with deep regret”

End Quote Bob Bell Royal Brompton and Harefield NHS Foundation Trust Bob Bell, the Royal Brompton and Harefield NHS Foundation Trust's chief executive, said: "Our decision to take legal action has been taken with deep regret.

"But the gravity of the consequences for patients of this deeply flawed consultation process left us no other option."

The decision to grant a judicial review was made following a hearing in July.

At that hearing, Alan Maclean QC, for the trust, said the joint committee was proposing under the "Safe and Sustainable" consultation on the future of children's heart surgery in England to reduce the number of centres in London from three to two.

Robust review

He said it was now clear that the Royal Brompton centre was going to be "ditched" following an "unfair and unlawful" consultation exercise "shot through with legal error".

But Neil Garnham QC, for the joint committee, said there had not yet been a final decision that the number of PCCS centres in London would be reduced from three to two.

The three-centre solution "has plainly not been excluded and the joint committee is proceeding with an open mind", said Mr Garnham.

Views in favour of retaining the Royal Brompton's services would be properly considered.

Teresa Moss, director of the NHS' Specialised Commissioning team, said: "Safe and Sustainable do not accept the allegations made today by the Royal Brompton.

"We will present our own case later this week when we provide evidence in court demonstrating that the principles and processes of the review are robust."

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Child respiratory unit 'viable'

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16 September 2011 Last updated at 15:49 GMT Child heart surgery is under threat at the Royal Brompton The children's respiratory ward at London's Royal Brompton Hospital could remain open if other crucial services are shut down, a report has found.

An independent panel found the unit in Chelsea west London would still be viable in the absence of an on-site paediatric intensive care unit (PICU).

The hospital's paediatric heart surgery unit is facing closure under a review of children's heart surgery in England.

Experts agreed the PICU would not be viable if the heart unit closes.

Dr Gillian Halley, consultant in paediatric intensive care and director of children's long term ventilation, said their work would be quite impossible without the PICU.

'Minimum requirements'

In response to the report she said; "To see that they (the panel) did recognise this, but have suggested that we downgrade the care we offer, is frankly shocking.

"The alternative they propose may not even meet the minimum requirements of safe clinical standards, never mind best practice."

The hospital's services were scrutinised as part of a national review aimed at streamlining paediatric congenital cardiac surgery services around the country.

It concluded with a proposal to end child heart surgery at up to five hospitals, as evidence showed larger units had better results.

But last month the Royal Brompton and Harefield NHS Foundation Trust won a judicial review into the decision, due to take place later this month.

Judicial review

The hospital argues the closure of the heart surgery unit could affect other vital services such as the respiratory unit that treats young people with cystic fibrosis and asthma.

But research by Safe And Sustainable, which is carrying out a consultation into the proposals, found the respiratory services could continue to be delivered safely in the absence of an on-site paediatric intensive care unit.

Adrian Pollitt OBE, who led the independent panel commissioned by Safe and Sustainable, said it "unanimously agrees with Safe and Sustainable that in the absence of an on-site paediatric intensive care unit paediatric respiratory services would remain viable at the Royal Brompton hospital".

Chief executive of Royal Brompton & Harefield NHS Foundation Trust, Bob Bell, said: "The review's failure to properly assess the knock-on effects on other Trust services and research programmes of the removal of children's heart surgery, is just one of a number of flaws in the consultation process."

A committee of primary care trusts will make a final decision on the closures later this year.

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Big drop in child mortality - UN

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15 September 2011 Last updated at 12:41 GMT Afghan child being immunised against polio The number of children under five who die each year has plummeted from 12 million in 1990, to 7.6 million last year, the UN says.

The reasons for the change include better access to health care and immunisation, says a report by Unicef and the World Health Organization.

But they warn that more needs to be done to reach UN development goals on reducing child mortality.

About 21,000 children are still dying every day from preventable causes.

But even the poorest regions have made progress. Child mortality in sub-Saharan Africa is declining twice as fast as it was a decade ago.

"Focusing greater investment on the most disadvantaged communities will help us save more lives, more quickly and more cost effectively," said Anthony Lake, the executive director of Unicef.

Many factors are contributing to reductions in child mortality, including better healthcare for newborns, prevention and treatment of childhood diseases, clean water and better nutrition.

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Sierra Leone in West Africa - one of the world's poorest nations - ranks among the top five countries seeing improvements in child mortality in the past decade. The others were Niger, Malawi and Liberia - also in Africa - and East Timor in South East Asia.

One of the reasons for Sierra Leone's success is that the government scrapped all fees for child and maternal health, said Ian Pett, the chief of health systems at Unicef.

About half of all deaths among under fives in the world took place in just five countries in 2010 - India, China, Pakistan, Nigeria and Democratic Republic of Congo.

Babies are particularly vulnerable. According to the report, more than 40% of deaths in children under the age of five occur within the first month of life and more than 70% in the first year of life.

In sub-Saharan Africa, one in eight children die before reaching the age of five. That compares with one in 143 children dying before five years old in developed countries.

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Does your child have a school nurse?

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Adalyne Rose tests her blood glucose levels with the help of her school nurse, Carla Moore.Michigan has the highest student-to-school nurse ratio in the country, at 4,411 to 1Nurses are handling bigger caseloads as students' medical needs become more complexParents should ask who is in charge of their kid's health while at school, expert says

(CNN) -- As a school nurse in Rochester, Michigan, Ronda Harrison has more than 15,000 students in 23 buildings under her care. She works out of the district's administrative offices and spends her days giving PowerPoint presentations to educators and communicating with parents over the phone.

"[It is] scary the fact that I'm responsible for so many schools," Harrison said. "I miss being 'Nurse Ronda.' "

The 16-year veteran has seen a lot of changes during her career as a nationally certified school nurse, but most notable is the shrinking ranks of her colleagues. Michigan has the highest student-to-school nurse ratio in the country at 4,411 to 1, according to the National Association of School Nurses. Utah isn't far behind, with a ratio of 3,637 to 1.

This means nurses are handling bigger caseloads, Harrison said, while students' medical needs are becoming more complex. And educators are now the ones doling out daily medication.

It's not all bad news, said Linda Davis-Alldritt, president of the National Association of School Nurses. Overall, there has been an increase in funded school nurse positions in the U.S. in the last decade. But the numbers vary significantly by state, and some districts have no school nurses at all.

School nurse Ronda Harrison has more than 15,000 students in 23 buildings under her care.

The bottom line, Davis-Alldritt said, is that the school nurse's job tends to be at risk during budget cut time.

"The big question for parents to ask when they drop their child off at school is, 'Who's going to be taking care of my kid's health care needs?' " Davis-Alldritt said. " 'What if my child gets sick? Who's going to take care of them? What are their qualifications?' That's an important question for parents to ask, and the school needs to have the answers."

It was certainly a question Wendy Rose asked when she and her husband moved their three children to Peoria, Arizona. Their 8-year-old daughter, Adalyne, has type 1 diabetes and celiac disease. The first requires constant monitoring of Adalyne's blood glucose levels; the second a gluten-free diet.

"Our school nurse has been invaluable," Rose said. "Insulin is a really tricky hormone -- a little in either direction can have drastic results. In reality, it could kill her. I would be very, very nervous sending her to a school environment for a large chunk of her day [with] no one there to monitor her."

Ever year before school starts, Rose meets with Adalyne's nurse, a member of the administration and all the educators she will be encountering -- from the art teacher to the librarian. A registered nurse herself, Rose had no qualms about putting up fliers around the school with her daughter's photo that said, "My name is Adalyne. I have diabetes" to alert staff if they noticed her wandering around looking confused because of low blood sugar.

Adalyne is not alone. One in every 400 children has type 1 diabetes, according to the Centers for Disease Control and Prevention, and children are more frequently developing type 2 diabetes, normally an adult disease linked to obesity.

In addition, the prevalence of reported food allergies in children increased 18% between 1997 and 2007. That's not to mention children with asthma or mental health issues.

Often, the people administering medication in schools are secretaries, principals or teachers. They're given instructions by parents or the district's supervising nurse but have little understanding of what the results should be, Davis-Alldritt said.

"Yes, they can give the medication -- that's not really hard," she said. "But it is really difficult to teach someone how to assess how that medication is working, or how it's not working."

Anecdotally, Davis-Alldritt has heard about mistakes made by untrained staff: the child who got ADHD medication twice from a busy principal; the secretary who didn't know how to properly work an insulin pen and ended up giving none; the child in Washington who died because no one knew to reach for her allergy autoinjector.

She recommends that parents advocate for more school nurses in their district and check in with the staff that handles any health needs.

"Parents have a strong, powerful voice, and they want to make sure their child goes to school and comes home and in the interim is protected and safe."

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Large reduction in child mortality - UN

September 15, 2011 12: 41 GMT date Afghan children against polio which each year has a number of children are dying under five fell from 12 million in 1990 to 7.6 million last year which says UN will be vaccinated.

The reasons for the change include greater access to health care and immunization, says a report by UNICEF and the World Health Organization (WHO).

But they warn that it must be more to be done to UN development goals on reducing child mortality.

Approximately 21,000 children still die every day from preventable causes.

But also the poorest regions have progress. Infant mortality in sub-Saharan Africa is twice as fast as a decade ago was declining.

"Focus on more investment to the disadvantaged communities helps us to save more lives, faster and more cost-effective effectively," said Anthony Lake, the Managing Director of UNICEF.

Many factors contribute to a reduction in child mortality, including better health care for newborns, prevention and treatment of childhood diseases, drinking water and better nutrition.

Most improved

Sierra Leone in West Africa - one of the world's poorest countries - is one of the top five countries see improvements in infant mortality over the last decade. The others were, Malawi, Niger and Liberia - also in Africa and East Timor in South East Asia.

One of the reasons for the success of Sierra Leone is that the Government all charges for child and the health of mothers, scrapped, said Ian PETT, the head of the health systems of UNICEF.

About half of all deaths under five years in the world found in only five countries in 2010 - India, China, Pakistan, Nigeria and the Democratic Republic of the Congo.

Children are particularly vulnerable. More than 40% of deaths in children under five within the first month of life and more than 70% in the first year of life occur, according to the report.

To reach in sub-Saharan Africa one of eight children five years ago. This compares with one in 143 children die in the developed countries, five years ago.

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Child respiratory unit 'viable'

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16 September 2011 Last updated at 15:49 GMT Child heart surgery is under threat at the Royal Brompton The children's respiratory ward at London's Royal Brompton Hospital could remain open if other crucial services are shut down, a report has found.

An independent panel found the unit in Chelsea west London would still be viable in the absence of an on-site paediatric intensive care unit (PICU).

The hospital's paediatric heart surgery unit is facing closure under a review of children's heart surgery in England.

Experts agreed the PICU would not be viable if the heart unit closes.

Dr Gillian Halley, consultant in paediatric intensive care and director of children's long term ventilation, said their work would be quite impossible without the PICU.

'Minimum requirements'

In response to the report she said; "To see that they (the panel) did recognise this, but have suggested that we downgrade the care we offer, is frankly shocking.

"The alternative they propose may not even meet the minimum requirements of safe clinical standards, never mind best practice."

The hospital's services were scrutinised as part of a national review aimed at streamlining paediatric congenital cardiac surgery services around the country.

It concluded with a proposal to end child heart surgery at up to five hospitals, as evidence showed larger units had better results.

But last month the Royal Brompton and Harefield NHS Foundation Trust won a judicial review into the decision, due to take place later this month.

Judicial review

The hospital argues the closure of the heart surgery unit could affect other vital services such as the respiratory unit that treats young people with cystic fibrosis and asthma.

But research by Safe And Sustainable, which is carrying out a consultation into the proposals, found the respiratory services could continue to be delivered safely in the absence of an on-site paediatric intensive care unit.

Adrian Pollitt OBE, who led the independent panel commissioned by Safe and Sustainable, said it "unanimously agrees with Safe and Sustainable that in the absence of an on-site paediatric intensive care unit paediatric respiratory services would remain viable at the Royal Brompton hospital".

Chief executive of Royal Brompton & Harefield NHS Foundation Trust, Bob Bell, said: "The review's failure to properly assess the knock-on effects on other Trust services and research programmes of the removal of children's heart surgery, is just one of a number of flaws in the consultation process."

A committee of primary care trusts will make a final decision on the closures later this year.

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Why you want to move your child care

16. September 2011 last updated at 00: 58 GMT by Dr. David Shortland Vice President of the RCPCH fifty children stations ' makes close ' all parents the best wants to care for a sick child. But - like this Government its first decision makes on the restructuring of hospital care - Dr. David Shortland, Vice President who says Royal College of Paediatrics and child health, that handles long way from home, is the best may be required.

As changes within the NHS and the financial troubles begin to reach hospitals search again on the affordability of qualified pediatricians keep available on call 24 hours a day in small hospitals, there are similar services within 30 minutes drive.

There are many units with dangerously low levels of the staff and doctors left to manage stations, because there simply not enough senior consultants are.

There is increasing pressure from the Government, children's services newly configured, so that senior pediatricians are in more specialized inpatient units, with smaller clinics or converted only during the day units of specialist nurses and visiting occupied consultants.

It is likely that up to 50 of the existing 218 stationary stations in the United Kingdom would have to close.

Many of these devices must now do experts on the ground, to see children them during the day than taking in-patients.

Although A & E departments only pediatric services does not, we all know that they are all under the same pressure.

Closures "inevitable"

It is completely understandable that parents make is concerned about their local services are way, but these changes important to specialized units can achieve and maintain the necessary excellence and quality.

If we want to protect our health care system, health of children and young people, parents travel provide further treatment, if their child must be one night.

As I would parents expect, and my child to have the highest quality care possible - and it is crucial that the standards of care in any way there are.

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can meet your local unit of the minimum requirements with regard to care for your child - would rather drive you further on the can a bit? "

Quote end these changes may doctors and nurses, the sickest children more be available to provide the local service while still for early detection and monitoring."

The proposed amendments will ensure that children, SR. and consultant with seen better competence and experience in a given time.

It is also important to note that not only paediatric services that feel the burden of services - we have opinion at odds last it about kids heart-surgery centers in the weeks seen.

The Government is also considering, reducing the number of local units and focusing on the regional centres for better care and outcomes for patients with a decision 2013 modifications until the end of this year and the year.

No matter what units under control are the quality of care must remain or just those who do not meet minimum requirements should be closed.

Changes should however only on the basis which ensure that the correct standards can be met to care and children's health is of paramount importance, taking into account the impact of the longer distances and transport.

Closure and changes to children's services are inevitable, but the reasons should be completely on the quality of care and support, so that children better.

Meet their local unit of the minimum requirements with regard to care for your child - can drive would not rather you further on the can a bit?

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Big drop in child mortality - UN

AppId is over the quota
AppId is over the quota
15 September 2011 Last updated at 12:41 GMT Afghan child being immunised against polio The number of children under five who die each year has plummeted from 12 million in 1990, to 7.6 million last year, the UN says.

The reasons for the change include better access to health care and immunisation, says a report by Unicef and the World Health Organization.

But they warn that more needs to be done to reach UN development goals on reducing child mortality.

About 21,000 children are still dying every day from preventable causes.

But even the poorest regions have made progress. Child mortality in sub-Saharan Africa is declining twice as fast as it was a decade ago.

"Focusing greater investment on the most disadvantaged communities will help us save more lives, more quickly and more cost effectively," said Anthony Lake, the executive director of Unicef.

Many factors are contributing to reductions in child mortality, including better healthcare for newborns, prevention and treatment of childhood diseases, clean water and better nutrition.

Most improved

Sierra Leone in West Africa - one of the world's poorest nations - ranks among the top five countries seeing improvements in child mortality in the past decade. The others were Niger, Malawi and Liberia - also in Africa - and East Timor in South East Asia.

One of the reasons for Sierra Leone's success is that the government scrapped all fees for child and maternal health, said Ian Pett, the chief of health systems at Unicef.

About half of all deaths among under fives in the world took place in just five countries in 2010 - India, China, Pakistan, Nigeria and Democratic Republic of Congo.

Babies are particularly vulnerable. According to the report, more than 40% of deaths in children under the age of five occur within the first month of life and more than 70% in the first year of life.

In sub-Saharan Africa, one in eight children die before reaching the age of five. That compares with one in 143 children dying before five years old in developed countries.

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HEALTH MANAGEMENT. Does your child have a school nurse?

School nurse Ronda Harrison has more than 15,000 students in 23 buildings under her care.

Adalyne Rose tests her blood glucose levels with the help of her school nurse, Carla Moore.Michigan has the highest student-to-school nurse ratio in the country, at 4,411 to 1Nurses are handling bigger caseloads as students' medical needs become more complexParents should ask who is in charge of their kid's health while at school, expert says
(CNN) -- As a school nurse in Rochester, Michigan, Ronda Harrison has more than 15,000 students in 23 buildings under her care. She works out of the district's administrative offices and spends her days giving PowerPoint presentations to educators and communicating with parents over the phone.
"[It is] scary the fact that I'm responsible for so many schools," Harrison said. "I miss being 'Nurse Ronda.' "
The 16-year veteran has seen a lot of changes during her career as a nationally certified school nurse, but most notable is the shrinking ranks of her colleagues. Michigan has the highest student-to-school nurse ratio in the country at 4,411 to 1, according to the National Association of School Nurses. Utah isn't far behind, with a ratio of 3,637 to 1.
This means nurses are handling bigger caseloads, Harrison said, while students' medical needs are becoming more complex. And educators are now the ones doling out daily medication.
It's not all bad news, said Linda Davis-Alldritt, president of the National Association of School Nurses. Overall, there has been an increase in funded school nurse positions in the U.S. in the last decade. But the numbers vary significantly by state, and some districts have no school nurses at all.
The bottom line, Davis-Alldritt said, is that the school nurse's job tends to be at risk during budget cut time.
"The big question for parents to ask when they drop their child off at school is, 'Who's going to be taking care of my kid's health care needs?' " Davis-Alldritt said. " 'What if my child gets sick? Who's going to take care of them? What are their qualifications?' That's an important question for parents to ask, and the school needs to have the answers."
It was certainly a question Wendy Rose asked when she and her husband moved their three children to Peoria, Arizona. Their 8-year-old daughter, Adalyne, has type 1 diabetes and celiac disease. The first requires constant monitoring of Adalyne's blood glucose levels; the second a gluten-free diet.
"Our school nurse has been invaluable," Rose said. "Insulin is a really tricky hormone -- a little in either direction can have drastic results. In reality, it could kill her. I would be very, very nervous sending her to a school environment for a large chunk of her day [with] no one there to monitor her."
Ever year before school starts, Rose meets with Adalyne's nurse, a member of the administration and all the educators she will be encountering -- from the art teacher to the librarian. A registered nurse herself, Rose had no qualms about putting up fliers around the school with her daughter's photo that said, "My name is Adalyne. I have diabetes" to alert staff if they noticed her wandering around looking confused because of low blood sugar.
Adalyne is not alone. One in every 400 children has type 1 diabetes, according to the Centers for Disease Control and Prevention, and children are more frequently developing type 2 diabetes, normally an adult disease linked to obesity.
In addition, the prevalence of reported food allergies in children increased 18% between 1997 and 2007. That's not to mention children with asthma or mental health issues.
Often, the people administering medication in schools are secretaries, principals or teachers. They're given instructions by parents or the district's supervising nurse but have little understanding of what the results should be, Davis-Alldritt said.
"Yes, they can give the medication -- that's not really hard," she said. "But it is really difficult to teach someone how to assess how that medication is working, or how it's not working."
Anecdotally, Davis-Alldritt has heard about mistakes made by untrained staff: the child who got ADHD medication twice from a busy principal; the secretary who didn't know how to properly work an insulin pen and ended up giving none; the child in Washington who died because no one knew to reach for her allergy autoinjector.
She recommends that parents advocate for more school nurses in their district and check in with the staff that handles any health needs.
"Parents have a strong, powerful voice, and they want to make sure their child goes to school and comes home and in the interim is protected and safe."

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