Although the dosing errors demonstrated in this study might seem inconsequential for a cold medication, the cumulative effect of 20% variation in the delivery of medications could have considerable clinical impact for drugs with tighter risk-benefit profiles. Clearly, the size of the spoon is important when patients pour their medications. We should encourage parents to use accurate measures (e.g., measuring cap, dropper, or syringe) rather than convenient utensils for liquid-medication dosing.

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Using ear drops to remove impacted ear wax is better than no treatment, but no particular sort of drops can be recommended over any other. Impacted ear wax is one of the most common reasons that people visit their general practitioners (family doctors) with ear problems, as it can cause reduced hearing, discomfort, and sometimes pain and dizziness. Ear drops (either oil- or water-based) are often prescribed to clear the wax or to aid subsequent ear syringing if necessary. The review of trials found that ear drops (of any sort) can help to remove ear wax, but that water and saline drops appear to be as good as more costly commercial products. The quality of the trials was generally low, however, and more research is needed.

The Bottom Line?

You should certainly try some type of wax softener before coming to the doctor, who would probably prescribe something just as effective as an OTC product. For more information, you can read this patient handout from American Family Physician.

By the way, you should never routinely use cotton swabs to clean your ears! There’s no need at all to routinely clean your ear canal, as mother nature does it just fine. I see many patients who have outer ear infections, and most have a story of routinely cleaning their ears with something, usually Q-tips. Remember that earwax is normal and protective; daily messing around in your ear canal sets you up for infections as well as risks of puncturing your eardrum.

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Food allergies in children, as a diagnosis, are more common than before. But are we over-diagnosing? The main issue is that the tests we perform, especially the blood tests for allergens, may show a positive “in vitro” allergy but “in vivo”, AKA in real life, there may not be a clinically significant allergy.

This growing issue is discussed in the always excellent Wall Street Journal Health Section (When Is Your Kid’s Food Allergy Really a Food Allergy?). One of their good quotes:

“Are these blood tests being overused? Possibly. Misinterpreted? Absolutely,” says Robert Wood, director of Pediatric Allergy and Immunology at Johns Hopkins Hospital, who is part of a task force writing guidelines for diagnosing and managing food allergies. “A lot of these kids truly have food allergies, just not to all the foods that they are being told they have allergies to.”

A national sampling from 2005-2006, which also included blood tests, found that 9% of U.S. children had a sensitivity to peanuts, 7% to egg; 12% to milk and 5% to shrimp. But experts believe that only about one-tenth of those children will actually have allergic reactions to those foods. Even the true rate of fatal reactions to food allergies is hard to gauge: Estimates range from as low as five to as high as 200 per year.

Here’s an excellent graph from the article:

The bottom line?

Many children do have serious food allergies, but perhaps they should be evaluated more frequently, if possible, by an allergist who can also perform allergy skin tests or a food challenge.

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A study in the current Otolaryngology, discussed in the New York Times (Vital Signs), had post-surgery children fill out a quality-of-life questionnaire; this group experienced “quality of life similar to that of normal-hearing peers”. That’s a wonderful result!

You can read more about this exciting technology from the U.S. National Instititute on Deafness and Other Communication Disorders.

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The best collection is from the U.S. EPA:

• SmogCity2: a fun and interactive game where you can control your city, like the Sims. There are two versions, one for ozone and another for particulates.
• Environmental Kids Club – they also have a section on air pollution
• AirNow: they have a series of pages for kids, students and teachers

Chinese Versions

I found a site from Taiwan: 空氣品質兒童網站

Anyone have other good links? Please share in the comment section below.

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My goal in sharing this is to encourage all schools — all over China — to review their air pollution action plans. And if they don’t have a plan, hopefully this slide show can drive the discussion within your schools.

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Many parents have been concerned about the alleged links between the MMR vaccine and a possible link to autism. As I’ve mentioned before, all medical societies continue to state that there has never been convincing proof of this, and now there is even less. The esteemed medical journal Lancet, which started this whole issue in 1998 with a provocative study, now officially and fully retracts that earlier study. Discussed here on BBC News, this is a major retraction and hopefully will finally put to rest this issue. The retraction comes a week after Dr Andrew Wakefield, the lead researcher in the 1998 paper, was ruled last week to have broken research rules by the General Medical Council. There was apparently a major conflict of interest:

Dr Wakefield was in the pay of solicitors who were acting for parents who believed their children had been harmed by MMR.

But this move goes further by accepting the research was fundamentally flawed because of a lack of ethical approval and the way the children’s illnesses were presented.

The statement added: “We fully retract this paper from the published record.”

Last week, the GMC ruled that Dr Wakefield had shown a “callous disregard” for children and acted “dishonestly” while he carried out his research. It will decide later whether to strike him off the medical register.

I think this is a major news story, as Dr Wakefield and others have caused incalculable damage to all vaccine’s reputations, and many unvaccinated children are getting sick and dying of diseases that should have been eliminated long ago. I personally think it’s disgusting that Dr Wakefield didn’t tell anyone he was getting paid by people looking for a connection, so he had a huge bias to find such a result. He clearly should lose his license to practice.

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During the winter many more children come to the consultation with skin complaints than during warmer months. Something in then happening during the winter, which may be the cold itself and air dryness.

The outside air humidity in Beijing these days is around 20%, which is very low and certainly too low for what is usually found comfortable, around 50%. This is caused by the intense cold which doesn’t allow much water vapor in suspension in the air.

Dry skin is thus very common, leading to discomfort, notably itch and further skin lesions. Children with a more sensitive skin can develop lesions not unlike eczema (dermatitis).

Doing the following may help, the principle being to keep the air where we live humid enough and our skin able to retain humidity:

1. humidify the air at home:
   1. humidifiers can help, though I find that those spitting a nebulization in the air deliver far too coarse aerosol for the water to stay in suspension in the air. Others ventilate above a humid sponge, producing a probably better air humidification. Humidifiers use electricity round the clock to be effective and should be mainained clean regularly.
   2. Water plates, offering a large evaporation surface have my preference. They deliver water particles in they air that are close in size to water molecules, becoming integral part of the environment, entering freely the airways. It is cheap, silent and can offer a pretty space in the home if fishes and plants are added. To increase the evaporation surface, porous stones can be installed on the plate, which will then absorb the water from the plate and easily evaporate from the large fractal-like surface of the stone.
2. Limiting bathing is often advised to children with sensitive and dry skin, which seems counter intuitive. It is not clear what in pure water may further damage the skin, but this seems helpful in many children.
3. avoid using soap (I would say even the “dermatologically tested lotion for sensitive babies and without soap”), as it will further remove the protective lipid layers from the already damaged skin.
4. add oil to the bath, like olive oil. I like olive oil because it is a natural compound, which is also beneficial when we eat it: it should be safe…
5. many lotions and creams exist, based on the same principle of catching water on the skin with phospholipids (the basic component of cell membranes.) They should be used right after the bath on still moist skin. I still wonder whether using a basic olive oil is not just as good, if not better. It is certainly cheaper.

Use a hygrometer at home to check the humidity level and how effective your efforts are. Every time you open the window, you will see that the humidity level drops quickly… If outside is not too polluted, that can’t be too bad!

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The major recent data came from studies in Africa, showing a dramatic decrease (more than 50%) in risk of HIV transmission among circumcised men. That benefit has been repeated and verified in other studies. Now, there are other studies showing additional benefits in decreasing herpes viral infections as well as the HPV virus. These diseases can cause herpes flares as well as genital warts and penile cancers.

There’s also good data that this benefits their female sexual partners as well. Not only would they benefit from the decreased risk of HIV, HPV and HSV, but women partners of circumcised men also have less frequent trichomonas infections and bacterial vaginosis.

All this data was reviewed in the latest issue of Archives of Pediatrics and Adolescent Medicine, and discussed in a Medscape article (New Data Support Long-Term Health Benefits of Male Circumcision). You can also read the official policy statement from the American Academy of Pediatrics, which was last revised in 2005 and does not reflect this new data.

The Bottom Line?

I find these latest studies very powerful and now am much more inclined to recommend male circumcision. As always, parents making this decision need to make sure that proper pain control techniques are used.

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Local Beijing expat and holistic nutrition coach Olivia Lee has recently set up her own blog at nutritioneer.net. She has occasional classes for nutrition information, and I wanted to pass along information on her next class: Introducing Solid Foods to Babies. The class is on Saturday, January 23rd. You can find out more on this class at this link: Upcoming Events » Nutritioneer.

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