Takirah Sleet, 7, and school nurse Michelle Marra assess her lunch to manage Takirah's diabetes. (H-L photo by Pablo Alcala)
As public health and education dollars shrink, school nurses are caught in the middle. The Lexington-Fayette County Health Department is among those scaling back its school-nurse program due to cuts, even as "more students with greater medical needs are appearing in classrooms," reports Mary Meehan for the Lexington Herald-Leader.
The cuts and the need present a difficult scenario: "In order to be educated, a student has to be healthy. How do you make that happen?" asked Mary Burch, president of the Kentucky School Nurse Association.
Schools nurses are not mandated in Kentucky, and the way school districts address the issue varies widely. Some districts use a nurse consultant to train school staff. The National Association of School Nurses recommends one school nurse for every 750 students. With 40,000 students, Fayette County falls short of meeting that level of care. The Fayette County school board helps to increase funding to keep nurses in place. About $600,000 would need to be reallocated. (Read more)
Tonsillectomies are the most common procedure for children requiring anesthesia. "The only problem is there's no evidence they work for most" kids, reports Sarah Cliff of The Washington Post.
"The procedure does show some benefits for those with really serious symptoms — very sore throats, fevers and other symptoms at least seven times in the past year — but no improvement for those whose indications are milder," Cliff reports.
Yet, more and more of the procedures are being performed. Between 1996 and 2006, the number of tonsillectomies increased by 74 percent.
"It's a silent epidemic of unnecessary care," said David Goodman of the Dartmouth Atlas of Health Care. "In most instances, it's done for patients with much less recurrent symptoms than should be indicated. I think a lot of this is unbeknownst to providers."
Unnecessary health care costs about $158 billion every year, Cliff reports, and the sum is partly to blame on demanding patients, to whom doctors acquiesce. Because doctors are paid based on volume, there is also an incentive to provide more care, even if it's not necessary.
Goodman said the medical education system is one main culprit. "Medical schools and graduate schools are failing us deeply," he said. "We need to move some of these ideas about the evidence being uncertain into the beginning of education. There's been such little work on that." (Read more)
A new poll shows nearly one in four grandparents say they store prescription medicines in places that can be accessed by children. Unintentional poisonings cause more visits to the emergency room for young children — one every 10 minutes — than car accidents, to say nothing of the threat of theft, a factor in the prescription-drug epidemic that is killing more Kentuckians than such accidents.
The most common type of prescriptions that are accidentally ingested are opioids, the poll found. The most common type of over-the-counter medicine ingested is acetaminophen, the active ingredient in Tylenol, reports research-reporting service Newswise.
The poll found that 23 percent of grandparents and 5 percent of parents store prescription meds in easy-to-access places. Eighteen percent of grandparents and 8 percent of parents said they store over-the-counter medicine in easily accessible spots.
"Emergency room visits for accidental poisonings among young children have become much more frequent in the last decade," said Matthew Davis, director of the C.S. Mott Children's Hospital National Poll on Children's Health. "We hope the results of this poll are a reminder to parents, grandparents and all those who care for young children: check around your homes to make sure that medicines are safely stored out of reach." (Read more)
Though the numbers are on the rise, on the whole, American children are safer than they ever were, according to the Centers for Disease Control and Prevention. The rate of death from unintentional injuries dropped 29 percent from 2000 to 2009. Deaths dropped from 12,400 in 2000 to about 9,100 in 2009.
Poisoning death rates rose dramatically, however‚ going up 91 percent in youths aged 15 to 19, "a byproduct of the rising prescription-drug abuse among teens who either obtain the pills illegally or swipe them from medicine cabinets of their parents or others," reports Timothy Martin for The Wall Street Journal. (Read more)
April is child abuse awareness month, and the state Cabinet for Health and Family Services is reminding Kentuckians that it's the law to report suspected child abuse or neglect.
"Protecting our children should be everyone's number one priority, and during the month of April, we are raising awareness about the warning signs of child abuse and how to report it," Gov. Steve Beshear said. "The cabinet works year round to educate our families and investigate every aspect of abuse. Together, we can make Kentucky a safer place for all our children."
To report child abuse, Kentuckians should call 800-KYSAFE1. Calls are anonymous. If the report meets the criteria for abuse, an investigation is conducted within 24 hours in most cases or, if the child is suspected to be in immediate danger, they are conducted within the hour.
Callers should try to know the child's name, approximate age, address, parents' names and location of the child when the call is made. They should also have names and phone numbers of other people who have information about the suspected abuse.
The ultimate goal is to reunite families when circumstances improve. "We want children to return home to a stronger, safer family," said Jim Grace, assistant director of the Department for Community Based Services' Division of Protection and Permanency.
The cabinet's handling of child abuse investigations and its reluctance to release records pertaining to child abuse deaths and near deaths has been a hot-button issue in the past year. The Courier-Journal and Lexington Herald-Leader both sued the cabinet for refusing to turn over records and a judge twice ruled the cabinet was wrong not to do so. Since, it has released hundreds of pages of records, but has chosen to redact, or omit, some of the information therein. In January, Beshear acknowledged the cabinet had been accused of "operating under a veil of secrecy in a supposed attempt to protect inept workers and a poorly designed system." Legislators have since heard hours of arguments about the issue, and a bill that would create an external panel to review child abuse cases involving fatalities and near-fatalities, while imposing more secrecy, is one of the few measures that could pass the General Assembly when it re-convenes for one day next Thursday to end its legislative session.
In its effort to increase awareness about child abuse, the cabinet offered strategies for parents to prevent abuse, including:
• never discipling a child when a parent's anger is out of control
• never leaving a child unattended, especially in a car
• learning the signs of physical abuse, nothing bruises, cuts, burns or other injuries a child can't explain
• teaching children the difference between "good touches," "bad touches" and "confusing touches"
• listening to a child when he or she doesn't want to go with something
• noting a change in a child's behavior or attitude
• teaching children what if he or she gets lost
• teaching children the correct name for private body parts
• being alert for talk that indicates premature sexual understanding
• paying attention when someone shows an unusual interest in a child
• making sure a child's school or daycare will only release him or her to a designated person (Read more)
This week marks the second anniversary of the Affordable Care Act and debate about its cost and benefits continues to be vigorous. But one thing that can't be denied "is that the ACA, on a most basic level, benefits vulnerable kids in Kentucky," writes Terry Brooks, right, executive director of Kentucky Youth Advocates, in an op-ed piece in the Lexington Herald-Leader.
"Today, because of the ACA, kids with pre-existing conditions like diabetes and asthma can't be denied the care they need," he writes. "And children across Kentucky are receiving preventive care like immunizations without their parents having to pay out-of-pocket costs so they can avoid illness and we can avoid unnecessary health care costs for preventable problems."
Brooks also notes that the ACA allows children to be covered under parents' insurance up to age 26.
If provisions of the ACA are not revoked, children can continue to benefit into their adulthood, Brooks writes: "They'll be protected from their insurance companies placing lifetime caps on their coverage and benefits, so if a child beats leukemia at age eight, she will still be able to get the care she needs if she relapses at age 20." That will translates to 360,000 children in Kentucky being protected. "And more than 180,000 Kentucky children will be able to receive preventative care such as well-child visits and other screenings with no out-of-pocket costs," he writes.
"So, yes, let's debate the pros and cons," he said. "But let's not deny the simple fact that the ACA is good for kids, and kids should be spared from the politics and animosity of this debate." (Read more)
If parents want to help their children lose weight, they should lose weight themselves, a new study shows.
"Parents are the most significant people in a child's environment, serving as the first and most important teachers," said Kerri N. Boutelle, associate professor of pediatrics and psychiatry at the University of California-San Diego. "They play a signifiant role in any weight-loss program for children, and this study confirms the importance of their example in establishing healthy eating and exercise behaviors for their kids."
Researchers analyzed 80 adults who were parent to a 8- to 12-year child who was either overweight or obese for five months. Some adults participated in a parent-only treatment program, while others were in a program designed for themselves and their child.
The study looked at "the impact of three types of parenting skills taught in family-based behavioral treatment for childhood obesity, and the impact of each on the child's body weight: the parent modeling behaviors to promote their own weight loss, changes in home food environment, and parenting style and techniques (for example, a parent's ability to help limit the child's eating behavior, encouraging the child and participating in program activities)," reports research-reporting service Newswise. (Read more)
For having childhood vaccination rates considerably higher than the national average, Kentucky's Department for Public Health was recognized by the Centers for Disease Control and Prevention this week.
Kentucky's childhood vaccination series coverage rate was about 80.6 percent in the last two quarters of 2010 and the first two quarters of 2011. Nationwide, the rate was 73.1 percent. Kentucky was also acknowledged for improving its childhood coverage from 63.3 percent in 2007. The data were collected from the annual National Immunization Survey.
Starting July 1, 2011, immunization requirements started being imposed for infants, toddlers and school-age children that were more in line with CDC recommendations and national pediatric standards.
"We have been working to increase immunization rates among Kentucky's children for several years now, including a campaign to make the public aware of the changes to the immunization schedule that took effect last July," said acting Health Commissioner Dr. Steve Davis. "The improvement in vaccine coverage helps improve the health and well-being of our fellow Kentuckians, and particularly our children." (Read more)
Preschoolers are increasingly having to undergo extensive surgery to get fix the cavities they've gotten from lack of brushing, get root canals or have teeth extracted.
Five years ago, the Centers for Disease Control and Prevention found the number of preschoolers with cavities had increased — the first time that had happened in 40 years. "Dentists nationwide say they are seeing more preschoolers at all income levels with 6 to 10 cavities or more," reports Catherine Saint Louis for The New York Times. "The level of decay, they added, is so severe that they often recommend using general anesthesia because young children are unlikely to sit through such extensive procedures while they are awake." (Times photo by Stuart Isett)
"We have had a huge increase in kids going to the operating room," said Dr. Jonathan Shenkin, a pediatric dentist in Augusta, Me., and a spokesman for the American Dental Association. "We're treating more kids more aggressively earlier."
Causes for the increase can be linked to lots of snacking and juice or other sugary drinks before bedtime; kids drinking bottled water rather than tap water; a lack of knowledge that infants should go to the dentist by age 1 to be assessed for cavity risk.
Parents can sometimes confused dental decay with teething and don't realize there is a problem until teeth break or the pain becomes so bad the child cannot sleep. (Read more)
With new lunch standards set to kick in by next school year, the Obama administration is looking at its next target in the school food landscape: vending machines. New guidelines are expected to be released in the coming weeks "for foods that children can buy outside the cafeteria," reports Ron Nixon of The New York Times. Kentucky already has some rules in place, may get stronger as a result of the new guidelines. (NYT photo by Kirsten Luce)
Students eat from one-fifth to one-half of their daily diet at schools, and the Centers for Disease Control and Prevention report 20 percent of American children are obese. As of 2007 in Kentucky, more than 37 percent of children were either obese or overweight, a study by the National Conference of State Legislatures shows. The administration wants to ensure that students eat what is good for them and avoid becoming overweight, Nixon reports, but there is strong pushback from the food and beverage industries.
A study by the National Academy of Sciences reports that about $2.3 billion worth of snack food and drinks are sold each year in schools nationwide. Schools have a stake in the fight as well, with candy sold in fundraisers often used to help pay for sports, music and arts programs. In Kentucky, the changeover to water, lowfat milk and fruit juices caused a downturn in revenue from the machines, but in most cases it appears to have rebounded to earlier levels.
The forthcoming guidelines are unknown, but officials predict they will be similar to the changes in the school lunch program, which reduced sugar, salt and fat. Those changes were a compromise after a fight between health advocates and the food industry. Nancy Huehnergarth, executive director of the New York State Healthy Eating and Physical Activity Alliance, said she expects another fight. "I think the food and beverage industry is going to fight tooth and nail over these rules," she said.
In Kentucky, schools are not allowed to sell food that competes with the national school lunch and breakfast programs from the minute students arrive until 30 minutes after the last lunch period. Only water, 100 percent fruit juice, lowfat milk and any beverage that contains no more than 10 grams of sugar per serving are allowed to be sold in school vending machines, as per state mandate. There are no limits as to what foods or drinks that can be sold in fundraisers. (Read more)
Kids are more likely to choose vegetables from the school cafeteria line — and eat them — if their tray contains pictures that subtly suggest the dining option.
That was the result of a University of Minnesota study, in which researchers placed pictures of green beans and carrots in the slots of the partitioned cafeteria trays at Richfield Elementary School.
On a typical day, 42 students took green beans and each student who chose them ate about 19 grams of them, reports Jeremy Olson of the Star Tribune. On the day in which the images were placed in the cafeteria trays, 96 students chose green beans and each student that took them ate about 19.1 grams.
When it came to carrots, 77 students took them and ate 31 grams of them on a typical day. On the day of the study, 238 students took carrots and ate about 27.1 grams. "That means that the students who always took carrots probably ate their usual amount, but that the students who took them for the first time ate less," Olson reports.
"Kids . . . don't want to do what they're told," said Traci Mann, a psychologist and one of five faculty members leading the study. "What kids want to do is . . . what their friends are doing or what they think their friends are doing." (Read more)
The Kentucky Department for Public Health is launching a new campaign to educate Kentuckians about the dangers of secondhand tobacco smoke and its potential effect. The campaign is funded by $281,000 from the economic stimulus package of 2009 and about $90,000 from the federal Centers for Disease Control and Prevention. This week the department will start running television, billboard and radio advertisements to show the dangers of smoke that comes from the burning end of cigarette, cigar or pipe or the exhaled smoke from a smoker. The ads, which will run statewide, highlight the link between secondhand smoke and dangerous illnesses in both adults and children.
The ads, produced by Louisville-based Doe-Anderson, feature people being unwillingly exposed to secondhand smoke in places such as residences and cars. Each ad carries the tag line, “Secondhand smoke is 100 percent unsafe, 100 percent of the time.”
Kentucky’s smoking rate remains the second highest in the country, with 24.8 percent of the adult population identified as current smokers, and secondhand smoke exposure is equally high. The health department says 39.5 percent of Kentucky children live with someone who smokes – the highest percentage in the country. Secondhand smoke has become a major public health concern because it contains approximately 4,000 chemicals, many of which are known carcinogens, and is responsible for approximately 3,000 cases of lung cancer deaths among nonsmokers each year.
The campaign is another project of the Kentucky Tobacco Prevention and Cessation program. Community interventions for tobacco cessation are available through local health departments staffed with tobacco control specialists, and the program operates a toll-free telephone line, 1-800-QUIT NOW. It also provides technical assistance, with the Kentucky Center for Smoke Free Policy at the University of Kentucky, to assist communities in seeking smoke-free ordinances.
More than 1,200 retailers, including CVS, Walgreens and Rite Aid, were issued warning letters by the Food and Drug Administration this year for illegally selling cigarettes to minors. FDA inspectors conducted 27,500 undercover checks by sending children under 18 into stores to buy cigarettes. These checks resulted in hundreds of letters being sent to retailers. Many of the warnings were sent to stores in rural areas where a recent U.S. Department of Health and Human Servicesreport found youth are more likely to use tobacco products.
Alina Selyukh reports for Reuters that under the Tobacco Control Act of 2009, the FDA was given broad authority over tobacco manufacture and sales. One of the provisions of the act "allows the agency to contract with states to inspect spots where youths could buy cigarettes or chewable tobacco." Under the law, store workers are required to check identification of anyone looking younger than 27. Selyukh writes: "FDA officials said they are on a mission to begin battling the stubbornly high U.S. smoking rates by keeping tobacco out of underage hands in the first place."
The agency posted the warning letters on its website last week along with a searchable database of all checks it conducted. The letters allow retailers to correct their infractions without fines, but repeat offenders could face fines or loss of ability to sell tobacco products of any kind. To see if retailers in your state, community or city were issued a warning letter, search the FDA database of compliance checks.
Children in rural areas face more health challenges than those in urban parts of the country, and are more likely to be poor, more vulnerable to death from injuries, and more likely to use tobacco. Rural families also have more difficulty in gaining access to health care. But the majority of parents, regardless of whether they live in urban or rural communities, say their kids are healthy.
These findings are from a report entitled "The Health and Well-Being of Children in Rural Areas: A Portrait of the Nation 2007," compiled by the U.S. Department of Health and Human Services' Health Resources and Services Administration. The report's results are based on the National Survey of Children's Health, conducted in 2007.
The survey classified children as living in an urban area, a large or well-populated rural area or a small or isolated rural area. Large rural areas include large towns with populations of 10,000 to 49,999. Small rural areas include small towns with populations of 2,500 to 9,999. Survey results were not broken down by state.
The report found children's overall health status does not vary substantially according to location. Four-fifths of parents said their children are in excellent or very good health, regardless of where they live.
But the analysis found rural children, as a whole, face more health risks than their urban counterparts. Only 67.6 percent of children in large rural areas and 69.8 percent in small rural areas are breast-fed, compared to 77 percent of urban children. (About 59 percent of new mothers breast-feed in Kentucky, compared to 75 percent nationwide.)
Rural children are also more likely to be overweight or obese — 34.6 percent of children in large rural areas and 35.2 percent in small rural areas compared to 30.9 percent of urban children. Rural children are also more likely to live with someone who smokes — one in three children in large rural areas and 35 percent in small rural areas do. Only one in five urban children do.
Though about 90 percent of children surveyed had health insurance, those in rural areas were more likely to have public coverage like Medicaid or CHIP. Urban children were more likely to have private insurance. Access to health care also remains a factor. Of the 2,052 non-metropolitan counties identified in 2010, 704 were designated as health professional shortage areas. Of those, 467 had shortages for dental care and 521 lacked adequate mental health services. To find if a Kentucky county is in a health professional shortage area, click here.
There are some advantages for rural children, however. They tend to be better protected and more connected to their families and communities. More than half of children in small rural areas shared a meal with their families every day in the past week. Children in small rural areas are also more likely to get physical activity every day (34.7 percent), though they are less likely to have access to community centers, parks or playgrounds. However, rural children are more likely to spend more than an hour each weekday watching television or videos — 60.9 percent of children in large rural areas did so, compared to 53 percent in small rural areas and 53.9 percent of urban children.
The data for the National Survey of Children's Health was generated using a random telephone survey, in which 2.8 million telephone numbers were randomly generated. After non-working and non-residential numbers were eliminated, the remaining numbers were called and surveyors spoke to respondents to see if children less than 18 years of age lived in the household. From each of those households, one child was randomly selected to be the focus of the interview and parents responded to the survey questions. Surveys were conducted in English, Spanish, Mandarin, Cantonese, Vietnamese and Korean.
Many school districts are reportedly opting out of a new federal pilot program that provides free breakfast and lunch to all students attending schools where poverty rates are high. They say budget constraints, fear of losing other federal benefits, and the possiblity of having to raise taxes to maintain the program are keeping them from participating. Kentucky, Tennessee and Illinois were the three states chosen to implement the program first.
When the U. S. Department of Agricultureannounced the Community Eligibility Program in March, officials called it a way to eliminate red tape for school districts and "make it easier for low-income students to receive meals in the National School Lunch and School Breakfast program." Districts would provide free meals to all students for four years, then claim reimbursement for them, as they do for students who already receive free or reduced meals, reports Heather Webb of the Salyersville Independent.
Webb reports that officials of the Magoffin County Schools officials said they are not participating because they want "see how the program works in the districts that do participate." The reimbursement rate outlined in the program is less than normal rates, and in the county, it would cause the current rate of 86 percent to drop to 47 percent.
Of Kentucky's 174 school districts, 102 are eligible for the program. However, only 18 of those eligible districts are participating, The Licking Valley Courier (which is not online) reported in its Aug. 11 edition. It said the Morgan County Schools declined to take part because they would have to pay 25 percent of the cost and feared they might have to raise taxes to cover that.
Bailey Richards of the Hazard Heraldreported that schools who do not have more than 60 percent of their students receiving free or reduced lunch can still participate in the program, but the respective school boards will have to pay the difference to cover all students. Perry County Schools Food Service Coordinator Linda Campbell told Richards her district could not afford to pay that difference, which would amount to about $300,000 a year out of its general fund.
Hazard Independent Schools Supt. Sandra Johnson told the Herald that she feared her district would lose funding from other government programs, like Title I and Family Resource Centers, which depend on the exact number of students receiving free meals, if they could no longer keep track of those numbers.
"In the face of poverty and other economic woes, Kentucky is one of the worst states in the nation when it comes to children's health," reports Jenna Mink of Bowling Green's The Daily News.
The state ranked 41st, according to the Annie E. Casey Foundation's 2011 Kids Count Data Book. "We no longer are close to being a bottom-10 state. We are among the bottom 10 states," said Terry Brooks, executive director of Kentucky Youth Advocates.
Kentucky scored particularly low when it came to child poverty, ranking third highest in the country. The study found 26 percent of Kentucky children live in impoverished homes. Kentucky also ranked low because of its poor economy and because it ranked high in the number of babies that are born with low birth weights, which can cause anything from infant death to behavioral and learning disorders. "While some causes are associated with chronic diseases among mothers, such as diabetes, Kentucky tends to have a high rate due to smoking during pregnancy," Mink reports.
The state also ranked high in terms of the number of children who have at least one parent unemployed. In 2010, about 122,000 Kentucky children had at least one parent who was looking for work. Only four other states and the District of Columbia had higher rates.
Brooks said Kentucky can improve its standing, and improve the welfare of its children, by doing three things. "First, Kentucky families should be given more information about benefits for which they qualify — last year, Kentuckians left $300 million in unclaimed benefits, such as food stamps and tax credits," Mink reports.
Brooks said he is also strongly in favor of passing a state earned income tax credit, which he said would help families make ends meet. Lastly, he recommends cracking down on businesses that advertise payday loans. "Those kinds of predatory practices contribute to the high price of being poor in Kentucky," he said.
The results of the report were not all bad, however. Kentucky improved on the number of teenagers who stay in school. The average number of kids in Kentucky affected by foreclosure was also lower than the rest of the country. Compare 2.3 percent, or 38,000 children, to the nation's average of about 4 percent. Brooks said the disparity is due to the fact that many Kentuckians rent and live in rural areas. (Read more)
