Tuesday, May 02, 2006

This, that, and the other, and stuff

OK, so my title is a little forced. They don't pay me for this, you know.


Cover the Uninsured Week: May 1-7 is Covered the Uninsured Week in America. Check out the Robert Woods Johnson page for lots of facts, figures, and local contacts. Kids who are uninsured tend to avoid primary care and end up in the ER. Or as one of our local neurologists told us today at a forum, one vial of insulin: $32.00. Three days in PICU in DKA: $18,000.00. Do the math.

Autism Risk and Safety Management: While this information checklist is intended for first responders and law enforcement professionals, it contains a lot of useful hints for health-care personnel, too. It is very easy to escalate situations into utter chaos when you are faced with a child or adult with autism who cannot understand what you want, cannot communicate to you in any way, and is incapable of cooperating. For instance, it would be really helpful to front-desk office staff to have some basic understanding about processing problems ("give them a few minutes to process your information"), personal space issues, sensory overloads, and use of repetitive movements for self-calming. In fact, many of these hints are just good ideas for all kinds of de-escalation situations.

Cumulative Social Disadvantage Associated with Poorer Child Health: This study looked at the effect of cumulative social disadvantages (poverty, minority race/ethnicity, low parental education, and not living with both biological parents) and found "the accumulation of social disadvantage among children was strongly associated with poorer child health and having insurance did not reduce the observed health disparities." Everyone in primary pediatric and family practice should bear this in mind: it's so much more than "is your baby up-to-date on his shots?", isn't it.

Finally: What Maternal/Child community nurses have been saying anecdotally for a long time: Mom's Attention Benefits Tiny Newborns for Years:

Dr. Karen E. Smith of the University of Texas Medical Branch in Galveston led the research, part of an ongoing study of 360 children born between 1990 and 1992. Many of these children were born at a very low weight -- around 2 pounds, on average -- while the rest were normal-weight, term newborns.

The researchers looked at whether a mother's responsiveness to her child during infancy and early childhood was related to intellectual development through the age of 10. They judged responsiveness by observing mothers and children interacting at home.

In general, the study found, when mothers reacted promptly to their child's "signals," were affectionate, used a positive tone of voice, and offered praise and encouragement, their children showed stronger intellectual development.

This was particularly true when mothers consistently showed this parenting style throughout infancy and the preschool years.

"An encouraging finding was that, despite the increased risk for slower cognitive growth found for those born at a (very low birthweight), responsive parenting was able to moderate this risk," Smith and her colleagues write.

Grand Rounds is up at Polite Dissent (no, I have nothing there this week!-but don't let that stop you) .



Anonymous Kim said...

Thank you for the autism behavior list. I ususally am able to ask the patient or the parent what works for them.

One time I had a patient who looked like he was throwing a "temper tantrum" except that he was eight. Not behavior you expect at that age.

I sat down and over the yells of the patient got the story from the mother about the child being autistic.

So there'a an autisic child under the bright ER lights, away from anything remotely considered "normal" to him and mom wrestling to keep him under control.

So...down went the lights, and down went the voices.
we consulted with mom on medications and how they should be given.
The patient eventually lay quiet in mom's arms on the gurney and it was decided he could have his medications at home.

Anytime a child comes in with ANY syndrome, I follow the parents guidelines. Geeze, who knows the kid better than they do?

And then I go look it up.......

6:49 PM  
Blogger mary said...

Well, I have been away from my blog, and missed your comment! Thanks for the thanks. I thought the checklist was really good, actually, and have proposed we give it to all the people doing "registration" functions at our hospital, too. Not just the clinical people. Pre-emptive measures (like your example of turning down the lights and muffling as much as possible the noise level) beat "take downs" anyday, in my book!


7:36 AM  

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