Increasing breastfeeding, The fifth vital sign, The electronic pediatrician, It's time for our little talk. Eye on Washington



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Increasing breastfeeding

Pediatricians have no doubt that breast milk is the best food for babies, but convincing mothers to share their view is another matter. Despite years of effort to encourage breast-feeding in the first year of life, pediatricians and other health-care givers have failed to get the message across to the majority of new mothers in America. And that deficiency is even worse among African-American women, whose rate of breastfeeding is, according to US Surgeon General David Satcher, MD, "alarmingly low." According to the most recent statistics, only 29% of all American women are still breastfeeding six months after giving birth; the figure for African-American mothers is 19%.

These low rates are a serious public health challenge, says Wanda Jones, Dr PH, Director of the Office of Women's Health, and will improve only when "we work together to put in place culturally appropriate strategies to promote breastfeeding, with particular emphasis on education and support from health-care professionals, employers, and family members—especially fathers and grandmothers." To that end, the Surgeon General's office has released a Blueprint for Action on Breastfeeding, outlining the steps that a consortium of federal agencies plans to take to promote breastfeeding. The Blueprint recommends that health-care professionals be trained in the basics of lactation and breastfeeding counseling; that women who return to work after childbirth have access to facilities that accommodate breastfeeding and pumping; that hotlines and peer counseling services be established to support breastfeeding mothers; and that research be conducted on the psychosocial issues involved in decisions to initiate and continue breastfeeding. The full text of the Blueprint can be found on the National Women's Health Information Center Web site, www.4woman.gov .

Despite these endorsements, some segments of the public seem to feel that breastfeeding can sometimes be too much of a good thing. Late last year, a judge in Illinois scheduled a hearing on whether the Department of Children and Family Services (DCFS) had acted properly in taking custody of a 5-year-old because he was still being breastfed and sharing his mother's bed. According to the DCFS, these actions constituted child abuse. Anthropologists, some pediatricians, and proponents of the family bed might disagree.

The fifth vital sign

Specialists in pain control have advocated for years that pain should be considered the fifth vital sign, to be routinely monitored for all patients. When pain is measured and documented as frequently as blood pressure and temperature, adequate pain control measures are more likely to be instituted.

The problem of inadequately treated pain is widespread and not confined to adult patients. A study of 103 pediatric patients who died of cancer, published last February in the New England Journal of Medicine, indicated that most (89%) had suffered pain or other symptoms in their last month of life and of those treated for pain, only 27% got adequate relief.

Now, the Joint Commission on Accreditation of Healthcare Organizations has begun to turn that situation around. Starting in January, hospitals, nursing homes, outpatient clinics, and home nursing agencies will have to document that they are regularly measuring and adequately treating pain to maintain their accreditation. The new standards require that patients be informed of their right to appropriate pain assessment and treatment, that institutions develop protocols for treating pain, that physicians be required to treat pain until it is relieved whenever possible, and that education on pain management be provided for physicians, nurses, and other health-care personnel.

The electronic pediatrician

From time to time, Updates has offered lists of Web sites pediatricians may want to consult or recommend. Here are some new additions for your list of favorites:

www.nutrition.gov , a new federal resource offering information gathered by the Department of Agriculture and other agencies on nutrition, healthy eating, physical activity, and food safety.

www.chestnet.org/children , for a curriculum on asthma designed for elementary school children. The curriculum materials were produced by the American College of Chest Physicians.

www.teenshealth.org , for medically reviewed health information targeted to teenagers. Topics include what the site calls Body Basics (general health and prevention); Mind Matters (relationships, emotions); Food and Fitness (nutrition, dieting, exercise, and sports); Health Problems (illness, chronic conditions); and Sexual Health (birth control, sexually transmitted diseases).

www.healthfinders.org , the federal consumer health Web site, providing links to more than 5,000 resources from government agencies, educational and health institutions, and not-for-profit organizations. Healthfinders has special resources for health-care providers, families, people who speak Spanish, and children 8 to 12 years of age.

It's time for our little talk

Most American adults believe that helping young people grow up with a healthy set of values is important. Yet according to a recent Gallup poll, far fewer actually pass on their beliefs about how to live the good life to their children. The poll was sponsored by the Lutheran Brotherhood (a financial services organization that serves Lutheran families) and the Search Institute, a social science research firm.

Regardless of income, education, or racial or ethnic background, most adults in the survey opted out when it came to sharing their beliefs about equality, honesty, tolerance, and how to handle money with children. In fact, adults appear to be as tongue-tied when it comes to discussing values with their kids as they are about discussing sex. Here are some examples of discrepancies between what adults say is important to communicate, and what they actually tell children:

  • While 80% of adults said it was important to teach kids core values of equality, honesty, and responsibility, only 45% actually discuss these things with kids.

  • While 77% say kids should be taught to respect the values and beliefs of different races and cultures, only 36% really do it.

  • While 73% say grownups should openly discuss their own values with kids, only 37% have such talks.

  • While 60% say they should discuss their religious and spiritual beliefs with children, only 35% do.

  • While 75% say adults should guide youngsters on how to handle money responsibly, most can't bring themselves to do it. Only 36% say they or adults they know have such conversations.

According to the authors of the survey, called Grading Grown-Ups: American Adults Report on their Real Relationships with Kids, these discrepancies are based on adults' feelings of vulnerability, their awareness that they themselves don't follow the precepts they should be advocating to their children. For more highlights from the study, go to www.lutheranbrotherhood.comor www.search-institute.org .

Eye On Washington

Inauguration day has now come and gone, and George W. Bush has been installed as the 43rd president of the United States. At this early stage in a new administration, advocates for children have little information to go on in assessing what the new administration will mean for children's welfare. The only clue is President Bush's nomination of former Wisconsin Governor Tommy Thompson as secretary of Health and Human Services. Governor Thomson is renowned for his stringent program of moving mothers from welfare to work while preserving their entitlements to childcare assistance and health insurance during the transition period.

Before leaving office, the outgoing Clinton administration managed to get in some last-minute licks:

  • The Omnibus Budget Act was finally passed, containing—along with basic financing to keep the government running—increased Medicare payments to hospitals and managed care plans and eased requirements for enrolling low-income children in Medicaid and Children's Health Insurance Program.

  • The President issued new rules to protect the privacy of medical records by requiring doctors and hospitals to have patients' consent to disclose medical information.

  • The secretary of Health and Human Services rejected as unworkable the plan for re-importing low-cost drugs passed by Congress the month before. The legislation had given the secretary this option.

  • The administrator of the Environmental Protection Agency issued a ruling making diesel vehicles like trucks and buses subject to strict emission control rules. Environmentalists described the revised regulations as the biggest step forward for cleaner air since the removal of lead from gasoline in the 1970s.

While the new administration is learning its way around, the federal agencies that shape day-to-day health and welfare policies are doing business as usual. For example:

The Department of Agriculture defined what Dan Glickman, outgoing secretary of agriculture, called "the strongest and most comprehensive standard for organic food in the whole world." From henceforth, foods carrying the department's organic food label will have to originate from farms or packers certified by a state government or an agency accredited by the USDA. Products labeled "made with organic ingredients" must be at least 70% organic, and foods labeled "organic" may not be produced using genetic engineering, ionizing radiation, or fertilizer made from sewage sludge.

The Surgeon General's Office issued a report on needed improvements in the field of children's mental health. According to David Satcher, MD, surgeon general until a successor is named, society must educate everyone involved in child care in identifying early indicators for mental health problems and train providers in scientifically proven approaches to assessment, treatment, and prevention of children's mental disorders. The full report, National Action Agenda for Children's Mental Health, is available on the Web at www.surgeongeneral.gov .


March 15-16, NAPNAP (National Association of Pediatric Nurse Associates and Practitioners) Conference on Pediatric Primary Care, Phoenix, AZ. For more information, call 856-667-1773 or visit the NAPNAP Web site, www.napnap.org .

April 23-25, Fourth Annual Conference on Vaccine Research, Arlington, VA. For more information, call the National Foundation for Infectious Diseases at 301-656-0003, ext 19 or e-mail info@nfid.org.

April 27-May 1, Pediatric Academic Societies Annual Meeting, Baltimore, MD. To register, call 281-296-0244.

Judith Asch-Goodkin
Contributing Editor


Updates. Contemporary Pediatrics 2001;2:13.

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