MS. ASCH-GOODKIN is a contributing editor for <italic>Contemporary Pediatrics</italic>.

Judith Asch-Goodkin

When the new Congress gets down to business this month, change will be in the air. With majorities in the House and, maybe, the Senate, the Democrats will have an opportunity to enact their vision of health care reform. It will be interesting to see what they do with it. For starters, incoming House Speaker Nancy Pelosi has already promised to introduce legislation that would allow the Centers for Medicare and Medicaid Services (CMS) to negotiate discounts on drug prices and to provide federal funding for stem cell research. 

Articles

Eye on Washington

Here's some advice to give parents who have a daughter with an eating disorder: monitor her internet activities. The World Wide Web includes a number of interactive sites that actively promote anorexia and bulimia. In a study published electronically in 

 last month, researchers found that patients at an eating disorder clinic at Stanford University often visited these sites, picking up so-called thinspiration images of obviously (to the pediatricians' eye, certainly) anorexic and indeed cachetic women modeling the latest fashions, performing as ballet dancers and gymnasts, offering themselves as role models to eating disordered teens seeking validation of their way of life. (Wilson JL, Peebles R, Hardy K et al: Surfing for thinness: A pilot study of pro-eating disorder Web site usage in adolescents with eating disorders. 

 2006;118:316355). These pro-eating disorder sites are, in the authors' words, "communities of individuals who engage in disordered eating and use the internet to discuss and reinforce their activities." The teens get more than validation: Almost all (96%) of the respondents to an anonymous survey reported learning new weight loss and purging techniques from the sites. (Samples from the Tips and Tricks portion of a randomly chosen site: "When you get hunger pains, curl up in a ball. It helps them go away," "Go into the kitchen and open and close the refrigerator, so your parents will think you're getting a snack," "Drink some vinegar before a meal. It tastes terrible, but it makes you less hungry.") 

Interestingly, the researchers also found that so-called pro-recovery sites, ostensibly intended to help teens who want to get over their disorder, are also a potent source of information on how to keep from eating or induce vomiting. Almost half the respondents reported learning new techniques from such sites. Parents of these respondents weren't clued in to where their daughters were finding support: More than half of the parents who participated in the survey did not know their daughters were visiting pro-eating disorder or recovery sites.  

Pro-eating disorder sites are not hard to find. Google "thinspiration," and you'll find plenty of them. Your parent education on this subject should warn of these internet enablers. 

Thinspiration

In a revised policy statement, the American Academy of Pediatrics (AAP) is voicing the ire many parents feel about tasteless advertisements shown on television at hours when children are likely to be watching. The AAP is particularly outraged by ads for erectile dysfunction remedies, and is urging parents and pediatricians to pressure TV outlets to cease airing them before 10 p.m. After all, the organization points out, birth control ads are rarely if ever seen on the tube during prime time, despite considerable evidence that advertising contraceptives could lower the teen pregnancy rates without encouraging teen sexual activity. And if there's no room for birth control ads when the kids might be watching, there's surely no excuse for promoting ED remedies in scenarios that portray sexual intercourse as a recreational activity.  

Sex isn't the only subject that provokes the AAP. Advertising also makes a significant contribution to childhood obesity, poor nutrition, cigarette smoking, and alcohol use. To counteract these slick ad campaigns for unhealthy products, the AAP recommends the promotion of media literacy for children. Learning to be critical viewers could armor kids against advertising blandishments. The statement also warns that TV is not the only avenue for ads directed at kids. Increasingly, advertisers are turning to the internet and infiltrating school systems around the country to turn kids into consumers of their often unhealthy products. The statement recommends that pediatricians work with parents, schools, community groups, and others to ban or severely curtain school-based advertising in all its forms, and requests pediatricians to ban magazines with ads for tobacco and alcohol from their waiting rooms. You can read the policy statement in full at 

Not before 10 p.m., puh-leeze!

Parents of children with a genetic disorder often turn to their pediatrician for information and support. You do your best, but an information source you can recommend with confidence would be a great help in these situations. Now the National Institutes of Health has created a Web site that fills the bill. Parents can find this site, Genetics Home Reference, on the World Wide Web at http://

. It's packed with reliable, up-to-date, understandable information about basic genetics and genetic disease. The site is particularly strong on explaining to new parents the rationale for the screening their newborn has undergone at the hospital and providing information on conditions the screening may have uncovered.  

The new initiative is the product of partnership between two government agencies, the National Library of Medicine (NLM) and the National Institute of Child Health and Development (NICHD), with the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), the American College of Obstetricians and Gynecologists (ACOG) and the American College of Medical Genetics (ACMG). Parents who access the site can find authoritative, user-friendly, commercial-free information on 500 genetic conditions and related genes: from Klinefelter, Pompe, Gaucher, Fabry, Canavan, and maple syrup urine disease to Down, Rett, Cornelia de Lange, and Lesch-Nyhan syndromes, and many, many more. The site includes an illustrated tutorial that explains the basics of human genetics, from the cellular level on up, and a glossary of genetics terms. The site is updated regularly by a scientific staff and reviewed by external experts. Check it out. 

New resource for parents on genetic disorders

Children with otitis media with effusion (OME) are frequent visitors to the pediatric office, as their parents seek your help in coping with this often chronic condition. A new review of multiple studies provides data to back up your advice about treating the condition with decongestants and antihistamines: Don't do it. These drugs, the studies conclude, are no better than placebo in alleviating symptoms or avoiding complications of OME. And they carry a significant risk of adverse side effects.  

The review finds no benefit from these therapies for any of the short- or long-term outcomes of OME, including resolution of the fluid, hearing problems, or the need for specialist referral. What's worse, however, is the finding that these remedies are often linked to "non-trivial" adverse side effects including insomnia, hyperactivity, drowsiness, behavioral changes, and variability in blood pressure that can impair a child's functioning at home and at school. In short, says Richard Rosenfeld, MD, director of pediatric otolaryngology at Long Island College Hospital in Brooklyn, NY, and co-chair of the AAP guidelines on the treatment of OME, "If you're going to subject a child to any medication that has a potential for harm, there needs to be some assurance of benefit." On the evidence, that's not the case here. As Dr. Rosenfeld says, "You're better off doing nothing." 

You can read the study online: Griffin GH et al: Antihistamines and/or decongestants for otitis media with effusion (OME) in children. 

What not to do for OME

According to a report from the Campaign for Tobacco-Free Kids, most states have allocated only a tiny fraction of their share of the settlement reached with tobacco companies for programs designed to curtail youthful smoking. Nationwide, for fiscal year 2007 state governments have allocated only $597 million for prevention programs, a sum that represents 37% of the minimum funding level recommended by the Centers for Disease Control and Prevention (CDC) and only 3% of the funds that will get from the settlement during that period. Only Delaware, Colorado, and Maine have allocated FY 2007 funds for smoking prevention at the minimum level the CDC recommends, while 28 states and the District of Columbia have allocated less than half the recommended amount. Missouri, Michigan, Mississippi, New Hampshire, and Tennessee have allocated no funds at all. M. Cass Wheeler, head of the American Heart Association, a co-sponsor of the report says, "States have been sorely negligent in failing to use money received in the multistate tobacco settlement on programs that could save lives and prevent youngsters from picking up the deadly habit." According to a statement from the American Medical Association (AMA), recent increases in youth smoking rates emphasize the need to fund programs that discourage youth smoking. The full report, titled "A Broken Promise to our Children," can be downloaded from the Campaign's Web site, 

. As advocates for children, pediatricians may want to lobby their state legislators to increase funding levels for these vitally important programs. 