UPDATES

UPDATES

Toward safer playgrounds

For most children, playground are happy places, made for the joys ofswinging, sliding, and climbing. But unfortunately, for some 200,000 USchildren every year, playgrounds are also a place where injuries seriousenough to warrant a trip to the emergency department occur. To find outwhy, the National Program for Playground Safety at the University of NorthernIowa surveyed more than a thousand playgrounds located in childcare centers,schools, and parks in 31 states (MMWR 1999;48: 329). Playgrounds were ratedon measures the Program considers vital for safety:

• Surfaces. The survey found that while 75% of the playgrounds provided soft surfaces (sand, wood chips, rubber matting), in 56% these materials were not deep enough to protect children from head injury, in 38% the soft zone around the equipment was not large enough, and in 20% children could be injured by hitting their heads against exposed concrete footings.
• Age appropriateness. Only 42% of the playgrounds surveyed clearly separated equipment safe for children 2 to 5 years of age from that suitable for older kids.
• Adult supervision. Researchers found children playing without supervision in 23% of playgrounds--even though 14% of these playgrounds had signs emphasizing the importance of supervision.
• Maintenance. One of four playgrounds had equipment with missing or broken parts, rust, splinters, or cracks.

How about the playgrounds in your community? It might be worth takinga look.

SUVs: Danger on the roadways?

When a car collides with a sport utility vehicle, the SUV passengersare more likely to walk away unscathed, right? Maybe not. The SUV is undoubtedlysturdier than the car, but it's also more likely to roll over in a crash.And when that happens, thefatality rate for SUV passengers is more thantwice as high as for car passengers. More than 60% of SUV occupants killedin 1997 died in crashes in which the vehicle rolled over. Which is why,come September, the US Department of Transportation will require manufacturersto put brightly colored labels on all SUVs warning buyers of the rolloverrisk.

SUVs and their ilk--minivans and pickup trucks--are also dangerous tothe occupants of cars. These vehicles were involved in half the deaths occurringin multi-vehicle accidents in 1997, even though they accounted for onlyone third of all registered vehicles. The SUVs higher ground clearance andcenter of gravity are primarily to blame for their propensity to roll over.And the National Highway Traffic Safety Administration recently concludedthat their design--weight, high bumpers, and resistance to bending whenthey crash--make them especially deadly to cars.

Websites to recommend

As more and more parents become concerned about the dangers unsupervisedwandering on the World-Wide Web can pose for children, they may turn toa trusted authority figure (like you) for advice. Here are some sites youmay want to consider--after you've checked them out.

• www.ctw.com, home page of the Children's Television Workshop, which produces Sesame Street. This site offers "lapware" (accessed from a safe position on the caregiver's lap) adventures for little ones as well as educational games for older siblings and information for parents.
• www.nick.com and www.nickjr.com, with information about Nickelodeon TV programming as well as games, preschool content, and a parents' forum.
• www.disney.com and www.family.com, with information and games based on Disney properties for children and information about Disneyland vacations for adults

For adults seeking parenting advice, you can suggest:

• www.babycenter.com, a highly commercialized site that--among all the consumer come-ons--also offers sound advice from a panel of child-care experts.
• www.zerotothree.org, with research-based advice on developmental issues like language learning, the timing of milestones, and helping toddlers acquire skills like learning to dress and graduating from crib to bed. The site includes a chat room for professionals and plansto open one for parents.

Last but not least, for parents who live in New York City or are planningto bring their children on a visit:

• www.angelfire.com/ny/NYCtoilets/index.html, a guide to the best public toilets in the Big Apple.

Pediatricians overseas

"It was an unbelieveable, thrilling experience," says ContemporaryPediatrics Editorial Board member Harlan Gephart, MD, "and one I wishother pediatricians could have shared." The thrill came from watchinga hearing-impaired child in Uzbekistan as she heard birds singing for thefirst time in her life, after the Seattle medical team Dr. Gephart leadshad fitted her with a hearing aid. That sort of experience is more thanample recompense, Dr. Gephart says, for the time he and colleagues he hasrecruited spend in Tashkent, Uzbekistan each year, testing hearing, fittinghearing aids, and training Uzbek health-care providers in hearing screeningand up-to-date ENT treatment methods. The incidence of deafness in childrenis unusually high in Uzbekistan, possibly as a result of the widespreaduse of potentially toxic doses of gentamycin for febrile illness in governmentclinics.

Dr. Gephart isn't alone in recommending international experience. Pediatricemergency physician Robby Mahadeo, MD, whose summer medical program in Guyanawas described in the March, 1998, issue of Updates, agrees. He returnedto Guyana last August with pediatric residents Suzanne Loiselle, Eric Wasserman,and Meena Moteelall and a team of nurse practitioners, emergency medicaltechnicians, and volunteer workers. This time they saw over 2,000 patients,800 of them children, at clinics and orphanages throughout the country.

If you want to consider volunteering your time or support to an internationalmedical relief effort, you can write to Northwest Medical Teams, the groupDr. Gephart works with, at PO Box 10, Portland, OR 97207; get in touch withDr. Mahadeo's Guyana Watch at 718-479-2962; or check the Directory of InternationalService Opportunities the AAP has just opened on its website, www.aap.org,for details on more than 100 groups that need pediatricians for short- andlong-term, paid and voluntary services abroad.

Solidarity forever

Of all the reactions doctors might have to the restrictions of managedcare, perhaps the most unexpected is the decision to join a union. Nevertheless,it is a decision more physicians are making. Salaried physicians are theobject of a vigorous recruitment drive being mounted by the Service EmployeesInternational Union, an AFL­CIO affiliate. The SEIU is planning to launcha $1 million national campaign to recruit postresidency physicians. Theunion estimates that nearly half the practicing physicians in the US arenow in salaried positions, making them eligible--and ripe--for union membership.Also recruiting physician-members are the American Federation of Teachersand the International Association of Machinists.

Some private practice physicians are also interested in unionization,because they want to tap unions' expertise and backing as they negotiatewith HMOs. The legality of such efforts is being questioned by hospitalsand HMOs under federal antitrust law provisions.

And now even the AMA is getting into the act. The Board of Trustees isdebating a request from the House of Delegates to form a collective bargainingunit to negotiate for their salaried members on such issues as quality ofcare, hours, and compensation. What would Morris Fishbein, MD, long-timeAMA leader who fulminated at any attempt to restrict physicians' individualityas "socialism," have said to that?

New drugs for children

The FDA's drive to increase the number of drugs in pediatric clinicaltrials seems to be bearing fruit. According to the Pharmaceutical Researchand Manufacturers of America organization (PhRMA), the number of drugs andvaccines currently under development for pediatric use now stands at 207,up from 187 in 1998 and 146 in 1997 (see graph below).

Those close to the end of the pipeline, either in late stage clinicaltrials or underFDA review, include drugs to:

• Prevent reperfusion injury in infants undergoing bypass operations for congenital heart defects
• Reduce muscle spasticity and improve gait in children 2 to 7 years of age with cerebral palsy
• Coat sickle-shaped cells so that they flow more smoothly through blood vessels, for infants and children with sickle cell disease
• Prevent rejection episodes in children as young as 3 months of age receiving kidney transplants
• Immunize infants against pneumococcal infection.

Calendar

Practical Pediatrics CME Course: June 25­27, Cambridge, MA; September2­4, Fort Myers, FL; September 30­October 2, San Francisco, CA.For program information, visit the AAP web site www.aap.org

July 20­23, Society for Pediatric Dermatology, Thompsonville, MI.For information, call 773-583-9780

August 22­28, Ninth Annual Pediatric Board Review, Bethesda, MD.Contact Continuing Medical Education, Children's National Medical Center,800-787-0700

September 26­29, Interscience Conference on Antimicrobial Agentsand Chemotherapy, San Francisco. Call ICAAC at 202-942-9254

October 9­13, American Academy of Pediatrics Annual Meeting, Washington,DC. Contact the AAP at 847-228-5003.

--Judith Asch-Goodkin

EYE ON WASHINGTON

May was not a quiet month in the nation's capitol. The balmy, springair seemed to be full of the sounds of violence, much of it directed againstchildren: children in Kosovo, on the run from burning villages, the saddestthose who had been separated from their families as they fled; childrenin Belgrade, their daily lives torn apart by NATO bombing raids; childrenin Colorado, dead on the floor of a high school library, victims of a murderousrampage by two of their classmates.

Congressional reaction to the violence was mixed. Congress voted to providemore funds than the President asked for to finance the NATO bombing whilerefusing to go on record as backing the war, and opened Senate hearingson a package of proposals to tighten controls on guns while wondering outloud whether gun control is the answer to tragedies like Littleton.

President Clinton continued his steadfast support of the bombing campaignand took a few hours from his Commander in Chief role to confront the problemof youthful violence at home. He presided over a special White House conferenceand called on Surgeon General David Satcher, MD, to study the issue andmake recommendations.

Meanwhile, in other federal actions,

• The Food and Drug Administration approved an over-the-counter test people can use at home to see whether they harbor the hepatitis C virus and released an internal study concluding that--despite the recall of five prescription drugs in the last year--the agency's speedier drug approval procedures had not jeopardized public safety.
• The Supreme Court agreed to hear appeals in cases that would define more specifically the kinds of state action required by the Americans with Disabilities Act and make a final decision on whether the FDA has jurisdiction to regulate tobacco products as drug delivery devices.
• The Federal Trade Commission proposed new rules to protect the privacy of children on the Internet, requiring commercial websites to get parental permission to seek information from children under 13 years of age.
• The Environmental Protection Agency put the final touches on new regulations for automobile emissions that will force large sport utility vehicles and pickup trucks to meet the same standards as cars.
• The CDC's Advisory Committee on Immunization Practices (ACIP) urged states to mandate varicella vaccination for school entry.