Norton Healthcare expands its footprint in Bowling Green with primary care; also adds a multi-purpose facility in Frankfort

Norton's new Frankfort facility (WLKY image)

Kentucky Health News

Norton Healthcare of Louisville is buying Bowling Green Internal Medicine and Pediatric Associates as its latest interest in the state's third largest city.

"It's about taking our specialized services out into the state," Dr. Steve Hester, Norton's senior vice president and chief clinical and strategy officer, told Don Sergent of the Bowling Green Daily News. "We appreciate the relationships we already have with providers in Bowling Green. Now we want to look at what things we can bring that aren't already there."

Norton spokesman Joe Hall todl Sergent that the company already has "significant investments" in Bowling Green through such Norton Children's Hospital specialty practices as heart, neurology and maternal-fetal medicine, and the new group will "bring primary care into the fold."

Sergent notes, "Norton is also expanding to other locales outside of Louisville. Earlier this month, it announced a new $12 million multi-practice location in Frankfort that will provide pediatrics, adult services and urgent care under one roof."

Poor oral health in children is not just from too many sugary foods; education, income and environment all play roles

CDC photo

While brushing your teeth is important to maintaining good oral health, dental-health experts say it's not the only thing responsible for poor oral health, especially when it comes to children in Appalachia, where sugar is usually blamed.

"It’s a common misconception that consuming sugary foods and beverages is the only cause of tooth decay. While that is undoubtedly a problem, there’s much more to good oral health," Daniel W. McNeil and Mary L Marazita write for The Conversation, a site for journalistic writing by academics. "It includes consistent brushing and flossing; eating healthy foods, like fresh fruits and vegetables; avoiding tobacco products; and wearing mouth guards while playing certain sports. Regular visits for dental care are also critical, as they provide an opportunity for cleanings and preventive care." 

McNeil and Marazita, who run the University of Pittsburgh's Center for Oral Health Research in Appalachia, say the region's poor oral health stems from a combination of factors beyond tooth brushing and other personal hygiene.

Poor oral health, they write, is more common among "people who have less formal education or lower incomes, marginalized ethnic and racial groups and those living in more rural areas, such as Appalachia," which has one of the highest rates of oral health problems in the nation. And among these groups, oral health issues tend to show up at younger ages. 

Other than education, behavioral and social influences, reasons for poor oral health can include genetic influences that dictate a preference for sweet foods, mouth bacteria that can lead to oral diseases, environmental factors such as air quality, access to healthy foods, the cost of dental care, access to transportation to and from the dentist, access to school-based programs, water quality and whether one lives in a community with fluoridated water, which can keep cavities from forming.

McNeil and Marazita note that cavities are the most common chronic disease in children, despite being preventable and that "more than 40% of children have tooth decay when they start kindergarten. . . . Dental problems in kids can lead to missed school, pain and embarrassment about visible decay, and missing or crooked teeth." 

They write that parental and caregiver role modeling can greatly influence children's oral health habits. Examples include drinking water instead of sugary beverages, eating a healthy diet, practicing good dental hygiene habits and expressing a positive attitude about going to the dentist. 

The article offers several other suggestions to improve oral health, saying one of the best things parents or caregivers can do is to take their child to the dentist.  

"The American Academy of Pediatric Dentistry and other professional health organizations recommend that children see an oral health care provider before age 1 or at the emergence of the first tooth," they write. "Access to dental treatment, especially preventive care, has been shown to improve oral health in families and their communities."

McNeil and Marazita also call for system-level changes that ensure routine dental care is affordable and accessible to everyone. They also call for integrating oral health practices into schools and educational programs, saying this will benefit all children regardless of their family's socioeconomic status.

Pikeville Medical Center now includes Eastern Kentucky's first hospital for children, thanks to federal grants and donors

Outpatient examination room in hospital
(Photo by Silas Walker, Lexington Herald-Leader)

Pikeville Medical Center has opened the first children's hospital in Eastern Kentucky.

The 13,400-square-foot facility, with 10 child-themed patient rooms and 13 outpatient examination rooms, is named the Drs. R.V. and Jyothi Mettu Children’s Hospital, for donors of $1.5 million to the project. Jyothi Mettu has been a pediatrician in the area for almost 30 years.

Pikeville Medical Center also received a federal-state Abandoned Mine Lands Pilot Program grant of $4.78 million and an Appalachian Regional Commission grant of $1.5 million to support the project.

PMC president and CEO Donovan Blackburn told Liz Moomey of the Lexington Herald-Leader that finding a way to serve the region’s children has long been a priority. “Our kids have to travel, it’s not right, it’s not fair,” he said. “As the largest single regional institution, we had to address that.”

"Prior to the children’s hospital opening, a child with appendicitis or a heart murmur would likely be referred to a specialist in Lexington," Moomey notes, quoting Blackburn: “A child will be able to see its extended family for support now during an overnight stay. A child will have access to urgent care instead of having delayed care when care is needed. A child will feel like they matter during some of their scariest times because of today.”

Children need 14 doctor visits before age 6, but preschoolers are increasingly not covered by insurance, especially in Kentucky

Kentucky Health News

In 2018, the number of Kentucky pre-schoolers without health insurance was about half again as large as the number had been in 2016, and that was one of the largest increases in the country over that time.

Researchers at Georgetown University in Washington, D.C., found that 4 percent of Kentucky children under 6 lacked insurance in 2018. In 2016, it was 2.7%. In percentage points, Kentucky's increase was the nation's fifth largest.

Chart by Stateline, Pew Research Center

Kentucky's percentage stayed under than the national average, but got much closer to it. The U.S. figure rose to 4.3% from 3.8%.

Ten other states — Alabama, Florida, Georgia, Illinois, Kentucky, Missouri, Ohio, Tennessee, Texas, Washington and West Virginia — also had significant increases, alarming health officials and experts.

Kentucky was one of seven states where the uninsured rate for children under 6 was higher than the rate for those 6 to 18.

"The first years of life play an outsize role in human health. They are foundational to the development of the brain and the cardiovascular, immune and metabolic systems. Early childhood is when medical interventions to correct problems in any of those areas are most likely to succeed," Michael Ollove writes for Stateline, a publication of the Pew Charitable Trusts.

"The American Academy of Pediatrics recommends that children visit the doctor at least 14 times before they turn 6 years old. During those visits, they should receive speech, hearing and vision tests, as well as screenings for genetic disorders and the possible effects of trauma or toxic exposure. The U.S. Centers for Disease Control and Prevention recommends that children under 6 receive numerous vaccinations, including for hepatitis A and B, diphtheria, whooping cough, polio, chicken pox, and measles, mumps and rubella."

Experts say children need 14 medical checkups before age 6.
(Photo by Amber Arnold, Wisconsin State Journal, via Stateline)

Al Race, deputy director at the Center on the Developing Child at Harvard University, told Ollove that a lack of health-insurance coverage often leads to a lack of health care, and can allow health problems to persist into adulthood instead of being corrected: “The earlier you can catch them, the easier it is and the better results you’ll have to put things back on track.”

After Kentucky expanded Medicaid under the Patient Protection and Affordable Care Act in 2014, the percentage of children in the state with health insurance rose to 96.2%, from 93.6%. Children are covered by the Children's Health Insurance Program, a program similar to Medicaid in which the federal government pays most of the cost, but the Medicaid expansion encouraged more enrollment. As the economy improved, adult Medicaid enrollment declined.

Supporters of the ACA said the reduction in the adult uninsured rate stalled because of the Trump administration's attempts to repeal and "sabotage" the law, through a shorter window to sign up for subsidized health insurance, huge cuts to the advertising budget and the number of "navigators" who help people find an insurance plan and the removal of the individual mandate to have insurance. Critics of the ACA blamed the stalled progress on rising premiums in the individual market.

Pediatric heart surgery has resumed at UK, in partnership with Cincinnati Children's Hospital

Magdalen Wilson, one of the first
UK pediatric heart surgery patients
since it re-opened, with parents Thom
and Lauren Wilson of Nicholasville

By Melissa Patrick
Kentucky Health News

After a five-year hiatus, Kentucky Children's Hospital is performing pediatric heart surgeries again, this time in partnership with Cincinnati Children's Hospital Medical Center – and it has already performed more than 12 since it opened in May.

"It is an important day here at the University of Kentucky and UK HealthCare to acknowledge that we've resumed the pediatric congenital heart program," said Bo Cofield, the hospital's chief clinical operations officer. "While we've got a fantastic pediatric cardiology program, we paused our surgical program a couple of years ago because it wasn't what we wanted it to be – a world class program – and we really believe that we've got that now through this partnership."

UK voluntarily suspended heart surgeries on children in 2012 after five died in 11 months. The program's chief surgeon, Dr. Mark Plunkett, left the program in 2013 with a $1 million settlement and an agreement to not talk to the news media. The letter of intent to partner with Cincinnati Children's was signed in 2015 and finalized in January 2016.

An internal review of the program didn't say why it was suspended. UK refused to release the program's death rates, but did so after the state attorney general ruled that it had to and CNN reported on the problem. The annual mortality rates averaged 5.8 percent, ranging from 5.2 percent in 2010 to 7.1 percent in 2012. The national average for a program of similar size was 5.3 percent.

The new program is a "one program, two sites" model that benefits both facilities, said Dr. Andrew Redington of Cincinnati Children's. He said the partnership allows UK's program "to provide the same level of care as we provide in Cincinnati" and Cincinnati's program to focus on "that high level of surgery that perhaps UK doesn't do," such as transplants.

Asked what specific changes they made to re-open, Cofield said, "We think there was some requirement for investment in certain things – more people, more training for the people that we brought in and clearly a focus on ensuring that we have the clinical infrastructure necessary to safely care for patients," including a "tele-video-conferencing" system that allows for seamless communication between the locations.

"What we want to do is provide the best level of care to as many children as possible, as close to home as possible," said Redington. "For patients and children who travel maybe a hundred or two or three hundred miles to get to Cincinnati, that's a burden and we recognize that."

Choosing care close to home was important to a Nicholasville family, whose infant is one of the first pediatric patients to undergo surgery in the new program.

Five-month-old Magdalen Wilson, who was born with several congenital heart defects, underwent open-heart surgery July 5 at Kentucky Children's Hospital and is doing well, said Thom and Lauren Wilson, her parents.

After learning about Magdalen's heart defect when Lauren was about seven and a half months pregnant, the Wilsons traveled between Nicholasville and Louisville twice a week to see specialist during the pregnancy. The Wilsons have three other children.

Magdalen was able to go home after she was born, but at about three months, she quit eating and her parents took her to UK's pediatric emergency center where she was admitted and assessed by the pediatric heart team. They learned about UK's new pediatric heart surgery program.

"We made the decision at that point to transfer our care to UK because it was close to home and the doctors and cardiologists we encountered in the pediatric intensive care unit were attentive and showed great concern for Magdalen's well-being," Lauren Wilson said in the news release.

Thom Wilson thanked all of their caregivers at UK and said they had received "excellent care." He later added that they appreciated that UK's pediatric heart surgery program was part of "a very well-known established program."

Magdalen's surgery was performed by Dr. James Quintessenza, who Cofield described as a "world-class pediatric cardiothoracic surgeon" and Redington called "one of the best surgeons on the planet." Quintessenza described the new program as a fine-tuned "orchestra." He added, "We are off to a great start."

American Academy of Pediatrics says children under the age of 1 should not be given fruit juice

Children who are less than a year old should not drink fruit juice because it offers them no nutritional benefit, according to new guidelines from the American Academy of Pediatrics.

“Parents may perceive fruit juice as healthy, but it is not a good substitute for fresh fruit and just packs in more sugar and calories,” said Dr. Melvin B. Heyman, co-author of the statement. “Small amounts in moderation are fine for older kids, but are absolutely unnecessary for children under 1.”

The statement, published in the journal Pediatrics, says the change was prompted by the rising rates of childhood obesity and concerns about dental health. The previous recommendation was no fruit juice under the age of 6 months.

The new recommendations for each age group are:

• Children ages 1 to 3 should be limited to four ounces, or 1/2 cup, per day
• Children 4 to 6 can have four to six ounces daily
• Children and teens 7 to 18 should have no more than eight ounces, or 1 cup, per day

The statement also suggests:

• Toddlers should not be given juice at bedtime.
• Toddlers should not be given juice from bottles or sippy cups that allow them to sip on juice throughout the day. This constant exposure can cause tooth decay.
• Children should eat whole fruits.
• Unpasteurized juice is not recommended for children of any age.
• If your child takes any medication, make sure grapefruit juice will not interfere with it. 
• Fruit juice is not recommended to treat dehydration or diarrhea.

Dr. Nikki Stone, associate professor of dentistry at the University of Kentucky College of Dentistry, created a "Drink Pyramid" graphic to educate children about healthy drinking habits that reminds parents and children that juice should only be consumed once a day.

“We know that excessive fruit juice can lead to excessive weight gain and tooth decay,” said co-author Dr. Steven A. Abrams. “Pediatricians have a lot of information to share with families on how to provide the proper balance of fresh fruit within their child’s diet.”

Obese children 9 to 11 should be tested for fatty liver disease; almost 20 percent of Kentucky's children are obese

Obese children from 9 to 11 should be screened for non-alcoholic fatty liver disease, according to new guidelines endorsed by the American Academy of Pediatrics.

Fatty liver disease is not a single disease process, but a range of conditions. It affects up to 38 percent of obese children and adolescents, and is commonly associated with other obesity-related conditions such as diabetes and sleep apnea, says a news release from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition.

“It has rapidly evolved into the most common liver disease seen in the pediatric population and is a management challenge for general pediatric practitioners, subspecialists and for health systems,” experts said in a articlein the Journal of Pediatric Gastroenterology and Nutrition.

Children with fatty liver disease often have no symptoms. The article's authors write that early screening is important because it can detect the condition before "the onset of irreversible, end-stage liver disease."

Almost 20 percent of Kentucky's children 10 to 17 are considered obese, the eighth highest rate in the nation, according to the State of Obesity report. The state ranks third for obese high-school-aged children, also at nearly 20 percent.

Screening requires a blood test; if it comes back positive, the child will need to undergo additional tests to determine if fat deposits are present in the liver and to rule out other conditions.

Treatment of fatty liver disease improves the child's diet, avoiding sugar-sweetened beverages and increasing physical activity. No medicines are available to treat the disease.

Pediatricians' national group calls for at least one nurse in every school; Ky.'s schools have a long way to go to meet that goal

By Melissa Patrick
Kentucky Health News

Kentucky's high schools fall far short of new recommendations by the American Academy of Pediatrics that call for every school in the United States to have at least one nurse on site.

Only 42.2 percent of Kentucky's high schools have a full-time nurse, 37.4 percent have a part-time nurse and 20.4 percent do not have one at all, according to research led by Teena Darnell, assistant professor of nursing at Bellarmine University.

"School nurses improve school attendance and decrease the dropout rate which leads to better academic outcomes. . . . Most importantly, they help keep the nearly 680,000 children attending public school in Kentucky safe, healthy and ready to learn," Eva Stone and Mary Burch said in an e-mail to Kentucky Health News.

Stone, an advanced-practice registered nurse, is the director of student support services for Lincoln County Schools. Burch is the health coordinator for Erlanger-Elsmere Schools.

The pediatrics academy's policy statement, published in its journal Pediatrics, replaces a previous recommendation that districts have one nurse for every 750 healthy students, and one for every 225 students who need daily professional nursing assistance.

"The use of a ratio for workload determination in school nursing is inadequate to fill the increasingly complex health needs of students," says the policy statement.

School nurses today monitor more children with special needs, help with medical management in areas such as attention-deficit/hyperactivity disorder, diabetes, life-threatening allergies, asthma and seizures and also provide immunizations, work on obesity prevention efforts and provide substance abuse assessments, among other things, says the statement.

As school nurses have been eliminated from school budgets, school-based health centers, which provide health care to students through a public-private partnership, have become popular. This model allows schools to bill private insurance or Medicaid for services to offset some of the costs.

Most recently, the Carter County Board of Education unanimously approved a one-year contract with Kings Daughters Medical Center of Ashland to provide its school health services, Joe Lewis reports for the Grayson Journal Times. The hospital will provide a nurse practitioner who will rotate throughout the district's schools.

That doesn't comply with the new guidelines to have one nurse in every school, but the program plans to use telemedicine to keep the nurse practitioner connected to the schools throughout the day.

"Unfortunately, Kentucky has no requirement to have a registered nurse in every school," Stone and Burch write. "Every school needs a nurse. What we see in the schools is a reflection of the health of the community. Kentucky is missing an incredible opportunity to not only keep children safe at school but also to implement a system of improving long term health in the commonwealth."

Childhood obesity rates continue to rise nationally while Ky.'s rate has leveled off, but 1/3 of kids are still overweight or obese

By Melissa Patrick
Kentucky Health News

Nationally, childhood obesity rates are not declining and severe obesity rates are still rising, especially among minority children. However, in Kentucky, child obesity rates have remained stable and the rates of obesity for minority children are not rising.

“Understanding the ongoing trends in obesity is important for public health and policymakers,” lead researcher Asheley Skinner, who is with the Duke Clinical Research Institute, said in a news release. “Our study suggests that more than 4.5 million children and adolescents in the U.S. have severe obesity."

The study, published in the journal Obesity, examined data from the National Health and Nutrition Examination Survey between 1999 and 2014 and found that 33.4 percent of children in the U.S. were overweight, meaning their body mass index (BMI) was above the 85th percentile for children their age. BMI levels estimate body fat based on height and weight.

In 2013-14, the study found that nearly 24 percent were obese, or above the 95th percentile, and that 2.4 percent were severely obese, or more than 140 percent of the 95th percentile.

The authors noted that the only statistical increase in child obesity since 2011 was found in those who were severely obese, which went up 2.1 percent, and this increase was most prevalent among African American and Latino children. The report also said that while there has been an increase in obesity in all age groups over the past 30 years, it "may be leveling off."

It could be that this "leveling off" effect is happening in Kentucky, where more than one-third of children are either overweight or obese.

The State of Obesity report found that 18 percent of Kentucky's high school students are obese, almost 20 percent of its 10- to 17- year olds are obese and 15.5 percent of its 2- to 4- year-olds from low-income families are obese. The report also shows that these rates have remained consistent for high school obesity since 2003, 10- to 17- year-olds since 2004 and the 2- to 4- year-olds since 2003.

The Kentucky Youth Risk Behavioral Survey also shows no overall statistical changes in obesity rates among  Kentucky's high-school students, including the state's African American high school students, whose rates range from from 15.5 percent obese in 2005 to 19.1 percent in 2013, or its Hispanic high school students, whose obesity rates were 15.5 percent in 2007 and 18.8 percent in 2013, the only two years with available data.

These reports did not break down the different levels of obesity.

Studies have shown that children with severe obesity are at an increased risk for heart disease, Type 2 Diabetes and even cancer when compared to children who are only considered overweight or mildly obese, says the release.

Skinner said it is time to expand local interventions and to find new treatment approaches.

"Addressing obesity in children is going to require a true population health approach, combining efforts at individual, healthcare, community and policy levels," she said in the release.

What is Kentucky doing about childhood obesity?

Kentucky's schools, as community partners in the battle against childhood obesity, are working to combat it through both nutrition and movement initiatives.

For example, most public Kentucky schools participate in the 2010 Healthy, Hunger-Free Kids Act that requires schools to provide healthier foods for their students; many schools participate in the Fresh Fruit and Vegetable Program, which provides a daily fruit or vegetable snacks to every student in participating schools; and more than 80 Kentucky school districts participate in the National Farm-to-School program.

Jamie Sparks, the school health and physical education director for the Kentucky Department of Education, said in an e-mail to Kentucky Health News that Kentucky schools are working to get students more active through several initiatives.

Sparks pointed out several successes, including school partnerships with the Alliance for a Healthier Generation initiative; a partnership with Humana Vitality called Students with Active Role Models, which encourages teachers and school staff to earn Vitality points by leading physical activity with their students; and partnerships with an online program called GoNoodle, which increases physical activity time in the classroom.

In addition, Sparks said, "Kentucky ranks second in the percentage of public schools enrolled with Let’s Move Active Schools. We have hosted 10 Physical Activity Leader trainings in the past three years."

But is that enough to make a difference?

Dr. Willian Dietz, author of an accompanying journal editorial, said there is a shortage of care-givers to treat obesity, noting that every primary care provider who takes care of children is likely to have about 50 pediatric patients with severe obesity in their practice. He also said that most of these providers aren't trained to treat childhood obesity, nor are they compensated appropriately, if at all, to treat it.

"We need more effective, cost-efficient and standardized approaches and services to manage children with the most severe obesity. This research emphasizes the urgency with which we must develop and validate a reimbursable standard of care for severe obesity in children and adolescents,"Elsie Taveras, spokesperson for The Obesity Society, said in the release.

It should be noted that Dietz, who is the director of the Global Center for Prevention and Wellness at George Washington University, said in his editorial that other data shows obesity rates have declined in two- to five- year olds. He said that this doesn't mean this study is incorrect because different time frames were used. "It all depends on how you look at it," he said. He did, however, acknowledge that severe obesity is increasing among adolescents.

He said, “The authors’ observation that severe obesity has increased is of great concern, especially because children with severe obesity become adults with severe obesity.”

U of L, Norton Healthcare end battle for control of Kosair Children's Hospital with cooperative agreement

A battle for control of Kosair Children's Hospital, between Norton Healthcare and the University of Louisville, has ended with agreements that give Norton clear control of the facility but give U of L 90 percent of the pediatric residency slots at the hospital.

"The dispute was ignited in August 2013 when Norton announced it would collaborate in pediatrics with the University of Kentucky and its Kentucky Children’s Hospital in Lexington – angering U of L medical school officials," notes Andrew Wolfson of The Courier-Journal. "U of L threatened in an Aug. 27, 2013 letter to evict Norton from Kosair, prompting Norton to file a lawsuit in Franklin Circuit Court. Norton built and operates Kosair Children's Hospital, but U of L uses it as its pediatric teaching and research hospital under a state land lease."

The 1981 lease will get an amendment that "secures Norton’s ownership and control of the hospital," the parties said in a press release. The agreement "says U of L will be Norton’s primary academic partner for pediatrics with at least 90 percent of the Norton’s residency positions at the children’s hospital being made available to U of L," Wolfson writes. "Norton can still pursue other third-party relationships, such as the previously announced intent to collaborate with UK Children’s Hospital, as long as its commitments to U of L are fulfilled."

The agreements became final upon approval by Gov. Matt Bevin and the University of Louisville Physicians group. The deal "also makes it possible for Norton to continue plans for more than $35 million in additional capital improvements to its children’s hospital over the next five years," the release said. "Those plans had been held up due to the litigation."

“This is great news for the Louisville community and the Commonwealth,” Donald H. Robinson, chair of the Norton Healthcare board of trustees, said in the release. “The agreements clear up critical land lease and ownership issues as well as bringing operational security to Norton while assuring stable financial support to the U of L School of Medicine in pediatrics. The real winners here are the families who depend on our children’s hospital for their child’s care.”

The agreement is for eight years and is automatically renewable. Norton will pay U of L $272 million over the next eight years for academic support and physician services, with an extra $3 million a year for "additional pediatric care investments" to be recommended by a committee with equal membership from each side. "U of L also will receive a one-time payment of $8 million to resolve any and all financial disputes from the past," the release said.

American Academy of Pediatrics calls for systemic changes to decrease climate change because children's health is at stake

The American Academy of Pediatrics has called on pediatricians, the health sector and politicians to solve what it calls "the crisis of climate change" to protect children from its immediate and long-term health consequences, Ashley Welch reports for CBS News.

"There is nothing more important than protecting the health, welfare and future for our children and grandchildren," Dr. Samantha Ahdoot, lead author of the statement and member of the AAP's Council on Environmental Health Executive Committee, told CBS. "Climate change is about the world in which our children are living today and in which they will be raising their own families. Their future is at stake, yet they do not vote and they have no voice in the debate. We have a moral obligation to act on their behalf."

The AAP's policy statement breaks down the health consequences of climate change into direct and indirect effects.

Direct effects of climate change on children

Direct effects include those that result from extreme weather events, including severe storms, floods and wildfires that scientists say are occurring more frequently and on a larger scale because of climate change, the report says.

"Children's unique needs place them at risk of injury, death, loss of or separation from caregivers and mental health consequences due to severe weather events," Ahdoot told CBS News, who is also the assistant professor of pediatrics at Virginia Commonwealth School of Medicine.

For example, about 250,000 children were evacuated and relocated as a result of Hurricane Katrina, and more than 5,000 were separated from their families, with the last one reunited with their family six months after the storm, according to the report. This took "a toll on their academic performance, behavior and mental health," Welch writes.

The report also notes that heat waves are lasting longer and are more severe, particularly putting infants and high school athletes at risk of heat-related illness and death. Annually, 9,237 cases related to heat are reported nationally in high school athletes, Welsh reports.

Indirect effects of climate change on children

Indirect health concerns include respiratory diseases; lengthened allergy seasons; smoke from wildfires; and infectious diseases like malaria, dengue fever, West Nile virus and others that could see more favorable conditions in a warmer climate. Increased transmissions risk of Lyme disease in the northeastern U.S. has been linked to climate warming in that area, says the report.

Climate change also alters agricultural conditions, which affects food availability and cost, further threatening the nutrition needs of children around the world, says the report. Added to that, the nutritional value of foods is changing because of increased carbon dioxide in the atmosphere, says the report.

"The report emphasized that children in the world's poorest countries, where health burdens due to disease and malnutrition are already disproportionately high, are most affected by climate change," Welsh writes.

The authors also note that climate change can cause population displacement and communities to fail, and thus will contribute to global instability and a potential increase in violent conflict.

Call to action

Based on "well-established evidence" that human-generated greenhouse gas emissions are the cause of climate change, the American Academy of Pediatrics calls for pediatricians, the health sector and governments to take action to address these issues, hoping that a universal concern about the health effects of climate change on children will drive this action.

"Failure to take prompt, substantive action, given our current knowledge, would be an act of injustice to all children," says the report.

AAP calls for the promotion of "energy efficiency and renewable energy production, surveillance and research on climate-associated health conditions, public awareness and education campaigns and funding for public transit and urban planning that supports open space, walkability and green building design," Welsh writes.

Legislative freshmen's bipartisan bill, now law, lets tax refund to go to pediatric cancer research, or part of it to rape crisis centers

Gov. Steve Beshear held a ceremonial signing Aug. 12 of a bill that creates a option on individual state income-tax returns to divert refunds for the study and treatment of pediatric cancer. “Cancer is the second leading cause of death in children,” Beshear noted.

From 2008-2012, Kentucky had approximately 200 cases each year of cancer among people up to the age of 19, according to the National Cancer Institute.

“This legislation will fuel innovative pediatric cancer research being done here at the University of Kentucky and will directly benefit some of the sickest children in the Commonwealth,” said Dr. Michael Karpf, UK's executive vice president for health affairs. “Thanks to this bill, now all Kentuckians will have the opportunity to advance pediatric cancer research.”

The bill was sponsored by freshman Sen. Max Wise, R-Campbellsville, whose young son is a pediatric cancer survivor. It became law June 24. Wise said he dedicated the bill “to the families who have been affected or are dealing with pediatric cancer,” and called it a testament to legislative bipartisanship.

The bill also allows individuals to designate a portion of their tax refund to a new trust fund to support rape crisis centers, incorporating legislation sponsored by freshman Rep. Chris Harris, D-Forest Hills (Pike County).

Pediatricians say middle and high schools shouldn't start class before 8:30 a.m., as a way to help sleep-deprived teenagers

The American Academy of Pediatrics recently recommended that middle and high schools not start of classes until 8:30 a.m. at the earliest.

An estimated 40 percent of high schools in the U.S. start classes before 8 a.m.; only 15 percent start at 8:30 a.m. or later. The median middle-school start time is 8 a.m., and more than 20 percent of middle schools start at 7:45 a.m. or earlier, according to the AAP release. The Kentucky Department of Education doesn't track school start times, but those are locally available.

When children become adolescents, their sleep-wake cycles begin to shift up to two hours later, meaning their bodies naturally want to go to bed and get up two hours later than before puberty hit, says the release. This makes it hard for teens to fall asleep before 11 p.m., and even more difficult to get to class by 7:30 or earlier the next day.

“The research is clear that adolescents who get enough sleep have a reduced risk of being overweight or suffering depression, are less likely to be involved in automobile accidents, and have better grades, higher standardized test scores and an overall better quality of life,” said Judith Owens, pediatrician and lead author of the AAP policy statement. “Studies have shown that delaying early school start times is one key factor that can help adolescents get the sleep they need to grow and learn.”

Pediatricians "urge middle and high schools to aim for start times that allow students to receive 8.5 to 9.5 hours of sleep a night," the group says. In most cases, that means a school start time of 8:30 a.m. or later, depending on average commuting times and other local factors.

Many studies have documented that "the average adolescent in the U.S. is "chronically sleep-deprived and pathologically sleepy." Reasons listed for this lack of sleep include homework, extracurricular activities, after-school jobs and use of technology that can keep them up late on weeknights.

And while students, parents, and all those involved need to learn about healthy sleep habits for adolescents and about the biological and environmental factors that contribute to insufficient sleep, schools should also adjust their start times, AAP said, citing studies showing that a too-early start time "is a critical contributor to chronic sleep deprivation among American adolescents."

“By advocating for later school start times for middle and high school students, the AAP is both promoting the compelling scientific evidence that supports school start time delay as an important public health measure, and providing support and encouragement to those school districts around the country contemplating that change," Owens said in the release.

Kentucky leads nation in percentage of children who have been diagnosed with attention deficit hyperactive disorder

Kentucky leads the nation in the percentage of children who have been diagnosed with attention deficit hyperactive disorder, according to the latest available data, which "showed that ADHD levels have risen steeply in the past decade across the nation," Laura Ungar reports for The Courier-Journal.

Ungar writes that "19 percent of Kentucky children ages 4-17 have been diagnosed with ADHD at some point, compared with 11 percent nationally and 16 percent in Indiana." Almost 15 percent of Kentucky children had the diagnosis in 2011, based on polling by the U.S. Centers for Disease Control and Prevention.

"We're probably over-diagnosing it to a certain extent," Dr. Christopher Peters, a psychiatrist and assistant professor of pediatrics at the University of Louisville, told Ungar. "But these numbers indicate a problem. There are many kids in need."

The high numbers could "reflect the state's rampant poverty, since ADHD is identified more frequently in the poor," Ungar writes. "Others say more children here may be genetically prone to the disorder or face other risk factors. . . . Studies show that at least a third of parents who had ADHD as children have kids with the diagnosis."

Any over-diagnosis may stem from "overworked primary care doctors who aren't experts in the disorder" and may be over-diagnosing — and possibly over-prescribing — both locally and nationwide," Ungar writes. "Roughly 8 percent of of school-aged boys nationally and nearly 4 percent of girls took ADHD medications in 2012, according to data from the pharmacy benefit management firm Express Scripts."

There are "financial incentives" for an ADHD diagnosis, Ungar notes. "A diagnosis may translate into disability payments if a child has measurable and serious problems, and students with ADHD can get extra help in school. . . . Experts say the higher numbers may also indicate greater awareness of the disorder, meaning the truly needy are getting the medication, therapy and support they deserve."

However, Dr. Carmel Wallace, pediatrics chairman at the University of Kentucky, "said parents rarely push for a diagnosis to get a disability check," Ungar reports. "And the threshold for disability is high."

Still Kentucky has high rates of children and adults getting Social Security disability payments, and ranks high in some risk factors for ADHD.

"Scientists also have linked ADHD to alcohol and tobacco use during pregnancy — although doctors said it's unclear whether smoking is a cause or simply occurs more often in families with afflicted children," Ungar reports. "Kentuckians smoke at the nation's highest rate and also have high rates of substance abuse overall."

Ungar's example of an ADHD child was, in preschool, "a tiny tempest — at times defiant, other times bouncing distractedly from toy to toy at daycare, while other children were absorbed in play," but as a second-grader "is doing well . . . with a mild stimulant and counseling." Here's a C-J video of another ADHD child and her mother discussing how they deal with it:

Winter can be risky time for infants if 'safe sleep practices' are not followed, health department says; here are several safety tips

Practicing "safe sleep practices" and creating a safe environment for your baby could mean the difference between life and death during these cold winter months, the state Department for Public Health says in a press release.

"Kentucky’s infant mortality rate remains higher than the national average. This is due in part to sleep-related accidents that could be prevented with safety practices,” Ruth Ann Shepherd, M.D., director of the department's Division of Maternal and Child Health, said in the release.

Shepherd stressed the importance of never smoking around a baby, since secondhand smoke can contribute to sudden infant death.

So, what are safe sleep practices? The American Academy of Pediatrics gives these guidelines to prevent sleep-related deaths and to keep infants safe and comfortable:

Babies need to sleep alone in a crib, bassinet or play yard. An adult bed is never a safe place for an infant to sleep.

Ask your health-care provider when it is time to give the baby his or her own room.

Always place infants on their backs to sleep.  This reduces the risk of Sudden Infant Death Syndrome (SIDS).

Do not put soft objects in a baby's sleeping space. That means no stuffed animals, toys, loose bedding, bumper pads or pillows.

Put your baby back in his or her own crib after breast feeding.  While breast-feeding reduces the risks of SIDS, falling asleep with your baby after a feeding can be dangerous.

How you dress your infant for winter sleep is also important to keep your infant safe. The health department offers these guidelines:

• Dress infants in one-piece pajamas or wearable blankets, layered over an undershirt or "onesie."  The important thing is to not let your baby get too hot from overdressing or being wrapped in heavy blankets.
• Keep the baby's room at a temperature comfortable for an adult.
• If you must use a blanket for warmth, only cover the baby's feet and lower body.  Do not let the blanket come higher than the baby's chest.  The blanket should also be tucked in around the mattress at the sides and bottom of the crib so that it cannot slide up to cover the baby's face.

Portable heaters can also create a danger to infants. “Remember to keep all portable heaters away from the baby’s sleep area. The baby can overheat if too close to a heater, get burned or tangled up in the cords of small electric heaters,” said Sherry Rock, who runs the child-fatality prevention program. “These are just small steps for parents and caregivers, but they can make all the difference in keeping infants safe.”

Petition drive from parents asks UK Healthcare to release mortality rates for cardiothoracic surgeries on children

More than 250 people have signed a petition asking the University of Kentucky hospital "to make public the mortality rates for pediatric cardiothoracic surgery patients from 2010, 2011 and 2012," Linda Blackford reports for the Lexington Herald-Leader. "All pediatric cardiothoracic surgeries were suspended at UK last fall amid an internal review." UK spokesman Jay Blanton said Monday the investigation is not complete.

"In May, the state attorney general's office issued an opinion that said UK must release mortality rates and other data about the cardiothoracic surgery program to WUKY, the university-owned radio station," Blackford reports. "UK has acknowledged that it calculated mortality rates for the program as part of its investigation, but has refused to release them, citing patient confidentiality laws." The Herald-Leader also requested the information under the Kentucky Open Records Act.

Read more here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpy

The three-year span includes the tenure of ardiothoracic surgeon Dr. Mark Plunkett, who no longer works at UK. Jennifer Allen, whose one-year-old daughter died after having three surgeries performed by Dr. Plunkett, wrote on the petition, "We deserve to know this information, we CAN understand and comprehend this information. It is our right to know and the right of the public!" Allen's daughter suffered from hypoplastic left heart syndrome, where the left side of the heart is underdeveloped and can't pump blood properly. Allen told Blackford she finds it "very suspicious" that UK won't release the information. UK says there were so few surgeries at times that patients' identities could be deduced.

Tabitha Rainey, whose son survived cardiothoracic surgery at UK, before being moved to another hospital, started the petition after being interviewed by CNN, which reported on the issue over the weekend and updated its story today with news of the petition. She said she doesn't accept UK's response that publicly releasing mortality rates would somehow harm patient confidentiality, telling Blackford, "There are no names and no dates, just the data on how many have passed on." (Read more)

Read more here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpReadmore here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpy, wrto

Health coalition asks Nickelodeon to stop marketing sugary and fatty snacks to children

A coalition of health groups thinks maybe it's time to enlist SpongeBob in the childhood obesity fight. Earlier this week, the groups asked the Nickelodeon Channel to stop airing commercials that promote unhealthy foods with the help of the doofy adorable sponge, among other lovable characters the children's channel employs. The letter the groups signed asked that Nickelodeon's parent company, Viacom, put in place strong nutrition standards for the foods marketed by it and by its characters. Their sentiment was strongly backed by the American Academy of Pediatrics.

Elise Viebeck of The Hill's Healthwatch blog quotes the letter: "Research shows that food marketing is an important factor contributing to children's poor diets and obesity. The majority of foods marketed to children remain of poor nutritional quality. The [federal Institute of Medicine] concluded that marketing puts children's health at risk." The letter went on to shake its finger at Nickelodeon for being behind Disney and other prominent child marketers on this front. (Read more)

This comes on the same day that the University of Missouri-Kansas City and the University of Kansas Medical Center release study results that found obese children may be more susceptible to food advertising than healthy-weight children, suggesting at least one reason the nation's childhood obesity rate could continue to climb as feared. (Read more)

No-Hit zones in place in pediatric wards of Kosair and U of L children's hospitals

Health professionals and other employees at Kosair Children's Hospital and the University of Louisville pediatrics unit were given an unusual tool this week when it was announced that their facilities are now No-Hit Zones. A program developed to maintain a calm, safe and caring environment for children and their parents, the No-Hit Zone initiative works to educate staffers on how to keep everyone on the ward safe from those who would lose their tempers while everyone around them is already in a stressful situation.

The policy is quite clear. No adult shall hit another adult. No adult shall hit a child. No child can hit an adult. And no child can hit another child while in the hospital environment.

The Kosair Children's, Kosair Children's-Brownsboro and U of L hospitals are now among only 30 children’s hospitals nationwide to implement the No-Hit Zone program. The Louisville effort has been led by Erin Frazier, M.D., FAAP, associate professor of pediatrics at the Uof L Children & Youth Project, and the Kosair Children’s Hospital Child Abuse Task Force, which Dr. Frazier chairs.

To learn about the No-Hit Zone, go here.

Study finds kids get more fat and calories when they eat out

Nobody's surprised to hear what researchers have now quantified: When children eat out, they take in more calories and fat than they would have at home. It doesn't matter if they're sitting down or driving through, at a fancy restaurant or at a McDonald's, we're not doing them any nutritional favors when we get in the car to go eat.

Jon Bardin of the Los Angeles Times reports that a study, published Monday in the medical journal Archives of Pediatrics & Adolescent Medicine, found that 2- to 11-year olds average an extra 126 calories when they eat a fast-food meal and 12- to 19-year-olds add an average of 309 calories. Full-service restaurants could added an average of 160 and 267 for the two age groups, respectively. And a lot of those calories were of the empty-nutrition kind that come from sugary drinks; kids in the study drank significantly more of those while dining out than when eating at home. (Getty Images photo)

In their report, writes Bardin, the authors argue that government intervention likely will be required to see any improvement: “Public policies that aim to reduce restaurant consumption -- such as increasing the relative costs of these purchases; limiting access through zoning, particularly around schools; limiting portion sizes; and limiting exposure to marketing -- deserve serious consideration.” (Read more)

Use of pacifiers could lead to very sick babies, study finds

Oklahoma State University researchers report that they have found a wide range of disease-causing bacteria, fungus and mold on pacifiers that young children had been using.

In research presented at the American Society for Clinical Pathology, scientists have shown that pacifiers can also grow a slimy coating of bacterial film that alters the normal bacteria in a baby or toddler's mouth, increasing the likelihood of colic and ear infections. It gets worse, according to study author Tom Glass, a professor of forensic science, pathology and dental medicine: The same types of bacteria found on a common pacifier have been linked to cardiovascular disease, metabolic syndrome, allergies, asthma and autoimmune diseases.

HealthDay reporters Barbara Bronson Gray writes that Glass said the problems associated with pacificers are also applicable to any removable orthodontic appliance like retainers, mouth guards and dentures. Glass said his researchers were particular concerned about their findings when they discovered that "many of the bacteria growing from the used pacifiers were resistant to commonly used antibiotics such as penicillin and methicillin. The development of such resistance to certain antibiotics does not cause the organism to be more infectious than other strains that have no antibiotic resistance, but it can make the infection more difficult to treat." Glass told Gray that he does not recommend that pacifier use. use. "After doing the study, I say why take a risk?" (Read more)