Screentime & the Developing Brain

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Earlier this month, a study published by Harvard University’s Center for the Developing Child concluded that letting infants watch tablet, phone, and TV screens might have negative effects on their academic achievement and emotional well-being down the road.

This long-term study evaluated nearly 500 children using an EEG at 1, 1-1/2, and 9 years of age. Their collected data demonstrated that extended screen time in infancy was associated with poorer executive functioning skills almost a decade later. Executive functioning skills refer to the brain’s proficiency with time management, organization, self-monitoring, adaptable thinking, and working memory. We use these skills every day academically, socially, and professionally.

The American Academy of Pediatrics discourages all screen exposure for babies under 18 months of age. That said, not all screen time is equal. Video-chatting with grandparents is a more interactive and valuable experience than passively watching animated videos. Digital educational content for infants and toddlers does exist, but for the most part that is just not how kids that age learn. The social back-and-forth is more identifiable in real life than through a screen and is particularly more impactful for younger brains. Additionally, the brightly-colored and rapidly-moving images on a screen are more activating than calming, and tend to elicit agitation in younger kids. That agitated state can be difficult to resolve when the screen is removed.

Similar results have been previously reported by the National Institutes of Health in their 2018 Adolescent Brain and Cognitive Development (ABCD) study which likewise assessed outcomes in 9 and 10 year-olds based on reported screen time at younger ages. For children who endorsed two hours of screen time daily as youngsters, their test scores for language and critical thinking problems were, on the whole, lower. For children who reported more than seven hours of screen time daily, MRI brain scans demonstrated evidence of thinning cortical tissue.

Both studies’ results suggest that increased screen time in infancy contributes to inferior development of executive functioning skills in childhood. However, more research is needed to define exactly which pathways are affected and what threshold of exposure is damaging. With more investigation, we will one day be able to better delineate the exact association between early exposure to screens and cognitive performance later on. For now, though, opting for face-to-face human interaction over digital substitutes when possible seems to have the best predictive outcome for growing brains, both cognitively and emotionally.

From UH Pediatrician and PSI Medical Expert – Dr. Carly Wilbur.

Click here for more great insights from Dr. Wilbur.

Vaping Guidance

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From 2011 to 2019, the CDC reported a 900% increase in vaping for teens in high school.

Vaping refers to the inhalation of aerosolized particles of a drug (marijuana or nicotine), mixed with flavoring. Most vaping devices contain a battery for power, a heating element, a place to insert the drug-containing liquid that will be heated until it vaporizes, and a mouthpiece.

Vaping was initially developed to help adults quit smoking, but quickly became popular among teenagers.

 

And while current reports estimate about 30% of high schoolers have vaped or currently vape, 5% of middle schoolers admit to the same.

On a chemical level, the nicotine salt delivered from a vape pen is far more powerful than the nicotine free-base that cigarette smokers inhale. This makes vaping nicotine extremely addicting. Studies show that teens who vape are 7 times more likely to smoke as adults. And over half the high schoolers polled admitted to having had their first vaping experience at age 11 or younger.

The immature frontal cortex of a teenager’s developing brain is uniquely susceptible to the harmful effects of nicotine. Regular use can cause long-term irreversible deficits in memory, attention, and concentration, and also mood disorders and permanent impairment of impulse control. Tobacco use in adolescence can also prime the brain for addiction to other stimulants of abuse like cocaine and methamphetamines.

Vaping is a $22 billion industry worldwide, with Juul being the predominant brand of electronic cigarette. Advertisements that falsely claim vaping is safer than smoking, along with child-friendly flavorings like birthday cake and mango, drive a powerful marketing campaign aimed at hooking younger consumers. The Surgeon General accurately labeled teen vaping an epidemic, and it’s a gravely dangerous one: nicotine-related deaths kill more adult Americans every year than alcohol, AIDS, car accidents, illegal drug abuse, murder, and suicide COMBINED. Let’s work together to keep our kids from vaping. It might even save their lives.

From UH Pediatrician and PSI Medical Expert – Dr. Carly Wilbur.

Click here for more great insights from Dr. Wilbur.

Separation Anxiety in Children

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As the school year gets underway, we start the weekday routine of saying goodbye as parents leave for work and children leave for school. For some, however, this parting of ways and the time leading up to it can be paralyzingly scary. Sometimes there’s an event to blame, perhaps a change in the family dynamic, like parents separating, the birth of a sibling, or a move to a new home or school. Other times, kids may be overly fearful for no obvious reason. Particularly for young children starting school for the first time, breaking away from the safety of their home and parents can be understandably anxiety-provoking. Whether we understand why or not, our job as parents and teachers is to help smooth that transition and make sure every child feels safe.

To help kids learn the language they need to communicate these fears and feel heard, and to assist us as adults to reinforce the message that even when our kids of out of sight, they’re not out of mind, here are a few children’s books that might help ease the separation.

LLAMA LLAMA MISSES MAMA (Anna Dewdney)

Excellent rhymes help this book skip along while Little Llama experiences first-day jitters at his new school.

I LOVE YOU ALL DAY LONG (Francesca Rusackas)

Owen worries about separating from his mom, but she reassures him that he’s in her thoughts even when they’re not together.

DANIEL GOES TO SCHOOL (Becky Friedman)

Not just for established Daniel Tiger fans, this book explains that the time away from each other is just temporary. There is a Daniel Tiger episode on the topic as well, that includes a “Grown-Ups Come Back” song.

THAT’S ME LOVING YOU (Amy Krouse Rosenthal)

From a prolific author of books for children and adults, this story reminds the child that they can recognize their parent’s love in everything around them.

   

WHEN MAMA COMES HOME TONIGHT and WHEN PAPA COMES HOME TONIGHT (Eileen Spinelli)

Instead of highlighting the separation, this book focuses on all the things we can look forward to once we’re reunited after our day apart.

THE INVISIBLE STRING (Patrice Karst)

This book covers not only separating for school or work, but also other life circumstances that keep us apart when we’d prefer to be together.

OWL BABIES (Martin Waddell)

When three owlets wake up overnight to discover their mother is missing, they worry. Children will relate to the little owls’ unease and their attempts to be brave.

We’ve all been there, rushing through the morning, praying to avoid a loud, ugly scene at the bus stop or at daycare drop-off. Any opportunity to reassure our children that our love is enduring, despite distance, is a chance to make them feel loved and valued, and to strengthen our relationship with them. Allowing them to feel safe also affords us a smoother transition and a more productive morning routine. And starting out on a positive note often sets the tone for the rest of the day.

Adequate preparation and messaging in anticipation of separating can make the morning goodbyes more pleasant for everyone involved.

From UH Pediatrician and PSI Medical Expert – Dr. Carly Wilbur.

Click here for more great insights from Dr. Wilbur.

What’s new in COVID boosters?

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The FDA has approved an emergency use authorization for a new bivalent booster shot to aid in the fight against COVID-19. Here’s what you need to know about these new vaccines.

Q: What is a bivalent vaccine?

A: Bivalent refers to the two separate virus strains whose mRNA instructions are included in the new booster vaccine. The original, or “ancestral,” COVID strain that circulated at the beginning of the pandemic, plus the current dominant strain, the BA.4/BA.5 subvariants of Omicron. It’s not uncommon to have more than one strain of a virus incorporated into a vaccine, for instance the annual flu shot is quadrivalent, meaning it’s comprised of four different flu virus strains.

Q: Who is eligible for this new booster?

A: These vaccines can be used as a first booster (after the primary series of COVID vaccines is complete) or the second booster (as long as at least two months have passed since the first booster). Moderna’s version is available to those 18 years and older, and the Pfizer-BioNTech brand is approved for ages 12 and up.

Q: Can this be used in patients who haven’t completed a primary COVID vaccine series?

A: No, the mRNA dose in the booster vaccine is lower than what is contained in the primary vaccines. Its efficacy is only studied as a booster dose and not as a primary vaccine.

Q: Does it matter which brand of vaccine was used for the primary series?

A: It does not. Both the Moderna and Pfizer brands can be used in patients who meet age and primary vaccine requirements, regardless of which vaccines they received as their primary series or previous booster shots.

Q: Should people who had a recent COVID infection get this booster?

A: While there is no perfect answer, the prevailing wisdom currently suggests that most healthy individuals will maintain a good immune response for at least 90 days after a COVID infection, essentially functioning as a booster dose.

Q: Why is this relevant? Isn’t the pandemic just about over?

A: Unfortunately in the United States, we continue to see a death rate from COVID of about 400 people per day. While that’s much lower than the more than 4,000 daily deaths reported in the US in January of 2021, it’s still significant. With mask mandates disappearing, more relaxed standards for physical distancing, school starting, and the anticipation of colder weather on the horizon that will move people indoors, this booster is one way to limit spread and severity of disease.

Q: Does this booster shot guarantee a person won’t get COVID-19?

A: The goal of broad-reaching vaccination campaigns is to reduce what the medical community calls morbidity (the severity of sickness) and mortality (death) for large populations. COVID vaccines are no exception. The goal in vaccinating the public was to reduce the burden of serious illness and loss of life. Don’t forget that early in this pandemic, hospitals were running out of staff and space for COVID patients. Vaccination works to reduce people’s viral load, which translates into milder symptoms, lower rates of contagion, fewer community outbreaks and therefore less of an opportunity for viral mutation into a new more dangerous strain, and of course fewer deaths.

Q: Have there been human studies on the new COVID-19 boosters?

A: The data has been extrapolated from studies on mice. While that might discourage some people, keep in mind that every year a new flu vaccine is formulated using different strains of virus and it doesn’t necessitate new human trials with each new configuration. Similarly, the COVID-19 vaccine didn’t change much except for the addition of this Omicron-specific strain. Waiting to collect data from human trials would negate the attempt to protect people before the anticipated increase in COVID cases over the winter.

Q: Will this be the last booster dose?

A: It’s impossible to predict with any certainty which direction this virus will go, but the greater percentage of people in the community that have protection against contracting COVID-19, the less likely we are to see another surge of serious illness in the population.

From UH Pediatrician and PSI Medical Expert – Dr. Carly Wilbur.

Click here for more great insights from Dr. Wilbur.

In Case of Emergency with Dr. Carly Wilbur

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Would you know how to respond in an emergency situation?

Some of us learned CPR in high school or for a babysitting class, but how many adults keep up with these skills? No one ever plans to be in an emergency situation, but quick thinking in a crisis can potentially mean the difference between life and death. Here are a few examples of emergency situations where recognizing the problem and knowing how to react could lead to rapid reversal.

BURNS—A first-degree burn makes the skin warm to the touch and pink. This is what a simple sunburn looks like. A second-degree burn creates blisters on the skin. If someone has been burned, immediately expose the area to cold water. This reverses the thermal injury and halts the progression of damage to the skin. A wet-to-dry dressing (moist bandage touching the skin and dry bandage outside of that) will do until proper medical attention can be sought.

ALLERGIC REACTION—Allergic responses range from sneezing to respiratory failure. Exposures to an allergen can trigger sneezing, runny nose, itchy eyes, rash (including but not limited to hives), itchy mouth, narrowing of the airway, facial swelling, and vomiting. The most severe kind of allergic reaction is called anaphylaxis. Insect stings, food ingestions, and medications are the leading culprits in anaphylactic reactions. An appropriately-dosed Epi-Pen (for under 60 lbs an Epi-Pen Jr, and for over 60 lbs a full-strength Epi-Pen) should help halt the progression of an anaphylactic attack. Immediate removal of the offending allergen, if possible, and delivery of Epinephrine should happen while emergency personnel are contacted.

POISONING—Finding a toddler chowing down on Tide pods, chewing fistfuls of Grandma’s blood pressure pills, or drinking Windex is harrowing. After removing the child from danger, call the Poison Control hotline at (800)222-1222. Try to have the name and dose of any ingested prescription medications available for that phone call. Do not try to induce vomiting; caustic substances will damage tissue for a second time on the way up the esophagus. For safety purposes, it is recommended that cleaning and laundry supplies be kept in a high-up cabinet that locks. Medications should certainly be kept out of reach of children and should be dispensed with child-safe lids.

OPIOID OVERDOSE—Signs of opioid or narcotic overdose (from medications like prescription pain killers) include pale and clammy skin, subdued respiratory drive, stupor, and sometimes vomiting. Narcotic medications are meant to dull pain, but too big a dose can be fatal. Street drugs can contain traces of Fentanyl, an extraordinarily addictive, powerful, and dangerous medication that can easily cause accidental overdose. A patient overdosed on narcotics may have very small pupils, itchy and pale skin, slurred speech, and a slack or droopy appearance. Narcan, a drug that reverses the effects of opioids, is now carried by most emergency workers, include police officers. Many schools stock it as well. It can be utilized as an injectable, but it is available as a one-dose nasal spray that anyone can deliver.

CARDIAC ARREST—In adults, heart attacks are often the result of years of untreated high cholesterol, obesity, poor diet, high blood pressure, or smoking, but in children this is not the case. Young people can suffer cardiac arrest if there is interruption of the normal electronic rhythm of the heart (due to electrocution, direct chest trauma, or medication overdose) or if there is underlying heart disease (Rheumatic valve damage, cardiomyopathy, infectious carditis). Damar Hamlin’s recent televised cardiac event after tackling a fellow NFL player raised awareness of heart attack risk in young people. Because he had access to an AED (Automatic Electronic Defibrillator) that could deliver a shock to his heart, his life was saved. Most sports arenas, schools, and gyms have EADs on site, and they come with instructions for the layperson to operate them correctly. For it to work, it’s vital that intervention happen in the first few minutes after a cardiac arrest, so knowing where to find the AED quickly is critical.

CHOKING—When food “goes down the wrong pipe”, it can get lodged in the airway and obstruct airflow. In the right setting (a restaurant or meal), a person who puts their hands up to the throat and starts sputtering should sound the alarm for a choking episode. Swift intervention is key, including performing the Heimlich maneuver, where the rescuer essentially hugs the patient from behind and delivers upward thrusts with grasped fists toward the diaphragm. Should the patient fall unconscious, gently lie them on their back and continue to provide an upward pushing motion just below the ribcage to encourage the offending morsel to be dislodged. There may be an instinct to reach inside the patient’s mouth to grab the item, but experts warn against a “blind sweep” of the mouth and throat, lest the item get unintentionally pushed down even further.

INJURY—High-speed collisions (car or bike or skiing accidents) can result in broken bones, concussions, internal organ damage, or lacerations that require repair. If there is even a question of head or neck injury, patients should not be moved until emergency care workers arrive. The risk of causing further damage (and possibly paralysis) from manipulating the spine is real, and should only be attempted if the patient can’t otherwise breathe.

SEIZURE—Whether a person has a known history of seizures or is having their first one, it can be scary to experience, even as an observer. Making sure the patient is safe from compounded injury (so, on the floor and away from sharp corners) is important. There are injectable medications that can stop a prolonged seizure, so finding out if the patient has that with them may help. The duration of seizure activity can drive the medical investigation, so if possible, try to note the time that a witnessed seizure starts and stops.

BLEEDING—Whether it’s an injury or a nosebleed, the best first step is to apply pressure to the site. In the case of an injury, there may be an open wound (cuts or scrapes) or a foreign body (nail or splinter). Applying a moist, clean towel to the area should help the blood clot without sticking to the cloth. For nosebleeds, have the patient sit down, lean forward (but not facing downward), and pinch the nose. Tissue that is rolled up and inserted into the nose can serve the same purpose. Ice or a cold pack will help to constrict blood vessels and slow bleeding as well.

In general, emergency medical situations warrant involvement from emergency medical personnel. If you encounter an unconscious, injured, choking, bleeding, or seizing individual, calling 911 is always a smart move. A quick-thinking and informed “good Samaritan”, however, can drastically change the outcome, and could even mean the difference between life and death.

From UH Pediatrician and PSI Medical Expert – Dr. Carly Wilbur.

Click here for more great insights from Dr. Wilbur.