Child Health: Labels Urged for Food That Can Choke

Earlier this year, we posted a blog on our website in regard to the American Academy of Pediatrics (AAP) policy statement in regard to the prevention of choking among children.  Earlier this week, the New York Times featured an in-depth story on an issue that is very much a part of this policy statement:  food choking hazards among small children.  The article discusses the advocacy efforts to place warning labels on foods, which pose a choking hazard to small children, as well as the proposition that small children should not be allowed to eat certain foods at all.  The article starts with an all too familiar setting that ended in tragedy:

On a July afternoon in 2006, Patrick Hale microwaved a bag of popcorn for his two young children and sat down with them to watch television. When he got up to change the channel, he heard a strange noise behind him, and turned to see his 23-month-old daughter, Allison, turning purple and unable to breathe.

As a Marine, he was certified in CPR, but he could not dislodge the popcorn with blows to her back and finger swipes down her throat. He called 911, but it was too late: by the time Allison arrived at the hospital, her heart had stopped beating. An autopsy found that she had inhaled pieces of popcorn into her vocal cords, her bronchial tubes and a lung.

Does this story make you think twice before giving your little ones popcorn?  On a personal note, I called my wife immediately after reading this story, and we discussed the fact that we should no longer allow our son, who is now two and a half, to have any popcorn. Ironically, she was on her way to take him to a movie that was going to be serving….you guessed it, popcorn.

Now, some of you may say “Well, little kids can choke on anything.”  Well, that is true.  However, there are some foods that pose an increased risk of choking.  Consider the dynamics of how a small child eats, as well as the size of their airway:

Children under 4 are at the highest risk, not only because their airways are small (the back of a toddler’s throat narrows to the diameter of a straw) but also because of the way their eating abilities develop. Front teeth usually come in at 6 or 7 months — so babies can bite off a piece of food — but the first molars, which grind food down, do not arrive until about 15 months, and second molars around 26 months.

“Between the ages of 3 and 4, they’re developing their ability to chew adequately and prepare for swallowing,” said Dr. Nisha Kapadia, a pediatric resident at Johns Hopkins Children’s Center.

When young children chew foods like peanuts, raw carrots and popcorn, some is ground down and some is not, and they tend to swallow unchewed bits of food that can block the airway or be inhaled into the bronchial tubes and lungs.

This concern and the tragic deaths associated with this concern have prompted several organizations to propose various options to attempt to prevent these injuries and deaths.  One such organization is the Center for Science in the Public Interest:

Some advocates say the government should put hazardous foods off limits to young children.

“The F.D.A. needs to set a uniform standard for cautionary information on food that should not be consumed by children under 5,” said Bruce Silverglade, legal director of the Center for Science in the Public Interest, an advocacy group that lobbied unsuccessfully in 2003 for a bill to require the Food and Drug Administration to develop food labeling regulations.

Where this debate will end up, we don’t know.  However, to think that in 2001 there were 17,500 children 14 years old and younger treated in emergency rooms for choking, with 60% of those events caused by food, there must be a way to create a safer environment for our children when they are eating.  Any suggestions?

Cerebral Palsy: Cord Blood Stem Cell Research and Treatment in Clinical Trials – Update

For those of  you who follow our blogs, you know well that this is a topic of interest for us.  It bears repeating – our job as lawyers is to properly investigate potential claims of malpractice in areas such as cerebral palsy and seek redress for our clients when the evidence demonstrates a connection between birth injuries and medical care, but the much more important topic for our clients and victims of cerebral palsy is in the field of medical research. It is through research efforts – including clinical trials – that this dreaded condition will be ameliorated and hopefully eradicated. Trust me, after practicing law for over 35 years, I’m not worried about job security – the frailties of the human condition will more than suffice to fill our file cabinets with people to help due to the negligence of others.

We have reported previously on various topics involving cord blood and stem cell research as they relate to a number of conditions, including cerebral palsy.  It seems that months have passed since there has been any significant news about two programs underway: one at the Medical College of Georgia and the other at Duke.  Earlier this month, an update came across the social media network via a post by Singularity Hub – Cord Blood Stem Cell Treatment for Cerebral Palsy in Clinical Trial | Singularity Hub.

Here’s our encapsulated version regarding the studies and Singularity Hub’s report.

Photo provided by MSNBC

Duke University

According to the website ClincalTrials.gov, Duke began a clinical therapeutic trial – identifier: NCT00593242 – in January 2008 (estimated completion date of January 2011) whose primary purpose is listed as treatment of newborns with hypoxic ischemic encephalopathy (HIE) – inadequate oxygenation in the perinatal period for purposes of this study – through the controlled “collection, preparation and infusion of a baby’s own (autologous) umbilical cord blood in the first 14 days after birth if the baby is born with signs of brain injury.” For information concerning the inclusion and exclusion criteria for participation in this clinical trial, see the online posting. Essentially, the babies are then to be “followed for neurodevelopmental outcome at 4 – 6 and 9 – 12 months at Duke’s Special Infant Care Clinic. MRI’s will be obtained between postnatal weeks 1 and 4, and, for study purposes at 4 – 6 postnatal months.”

While other aspects of processing and administration are no doubt part of the key components of this project, it is readily apparent that the end-point goal is discovery of an effective treatment of cerebral palsy for the identified neonates in the study and then development of a second stage clinical trial to take such treatment modality to a greater number of potential beneficiaries.

Medical College of Georgia

For detailed information on this study, which began in February of this year, similar information is available through ClinicalTrials.gov under identifier NCT01072370.  This clinical trial investigation has a patient population consisting of children from ages of 2 to 12, “whose parents have saved their infant’s cord blood, who have non-progressive motor disability, and whose parents intend to have a cord blood infusion.”  Again – for full details regarding inclusion and exclusion criteria, see the full online posting.

For those parents who may be interested in determining if their child would qualify to participate, the study is still recruiting participants.  The contact information is also available at this link: Contact: James E Carroll, M.D.     706-721-3371     jcarroll@mcg.edu

Today’s report from Singularity Hub provides some encouraging – albeit anecdotal – news of potential progress.

The anecdotal evidence in support of treating cerebral palsy with cord blood stem cells is astounding. Much of it has actually been been performed at Duke University by one of the investigators in the pilot study: Joanne Kurtzberg. Among those that have been successfully treated at Duke include Ryan Schneider, Maia Friedlander, Chloe Levine, and Dallas Hextell. All had CP or CP-like symptoms and all made remarkable recoveries after cord blood stem cell treatments. Dallas Hextell, who showed improvements just 5 days after his therapy was featured on the Today show (the original report contains video compliments of MSNBC).

In addition to the early good news coming out of these projects, one other lesson is learned – for the time being, the storage of cord blood is an important component for those hoping to participate in such studies – particularly that being conducted at the Medical College of Georgia.  We have earlier reported on this topic as well.  You may want to refer to our early posting for some basic information if you are interested.

Obviously, the implications – if these projects prove to be successful – are far-reaching. The enthusiasm of the participants in these research projects is not limited to them alone. The words of the author, Aaron Saenz, from Singularity Hub somewhat tells it all:

So we have some exciting news for cerebral palsy, and some exciting news for those thinking about cord blood. What about the rest of us? Well the MCG and Duke work has some far reaching implications. Neurological damage, whether it’s caused by oxygen deprivation or some other injury, is one of the most difficult things to heal in the body. Work in animals (like that done by Carroll on rats) show that stem cells can not only help damaged brain cells recover, but they can also replace cells that have died. We may find that stem cells therapies have a wide range of applications for many different forms of brain damage. Kurtzberg is researching many different ways cord blood could be used (autologous or through donors) to treat a variety of conditions. In other words, today stem cells conquer cerebral palsy…tomorrow, the world.

Let’s all hope that Mr. Saenz is a prophet.

Children With Cerebral Palsy May Benefit From Cell Transplants

Since our firm at any given time handles a number of cases involving cerebral palsy, I am constantly trying to find useful information about new developments in therapy, research, procedures – anything relevant to the topic of preventing or helping those who suffer from cerebral palsy.

This morning I came across a report in Medical News Today –Children With Cerebral Palsy May Benefit From Cell Transplants – which, I must admit, I had not heard of before.  Apparently a group of Chinese researchers are now hypothesizing that a type of cell known as olfactory ensheathing cells (OECs) may hold promise for treatment of infants and those in early childhood with cerebral palsy.  

Clearly this research by the Chinese is not yet being conducted on a large scale level. Nevertheless, I thought I would report on this since the ‘science’ (in which I don’t purport to have expertise) seems logical and potentially noteworthy. With those qualifiers in mind, here is what’s behind this ‘thinking.’  Rather than try to give you the layman’s recap of OEC’s, I’ll let the article speak for itself.

Transplanted OECs, known to retain exceptional plasticity and promote olfactory blood vessel growth while offering neuroprotection, have been demonstrated to be potentially useful for a number of neurological disorders, including multiple sclerosis, spinal cord injury and amyotrophc lateral sclerosis (ALS).

So what does this mean for those who suffer from cerebral palsy? The corresponding author Dr. Hongyun Huang of the Beijing Rehabilitation Center provides the details:  “We conducted a randomized, controlled clinical trial with 33 volunteers, 14 of whom completed the six-month study, to determine if transplanted OECs were effective in treating children and adolescents with CP, given that CP shares many of the same features of other degenerative diseases.”

According to Dr. Huang, a protocol was developed from this hypothesis based on their knowledge of a key location “in the brain’s frontal lobes (defined as the “Key Point for Neural network Restoration (KPNNR)” based on previous studies) for injecting OECs and that the injected OECs would produce Schwann cell-like myelin sheaths around demyelinated axons.”  Demylinated axons are often referenced as a rather consistent finding when imaging the brains of victims of cerebral palsy.

Buoyed by the findings of this admittedly small trial group, Dr. Huang reports:

“Our results showed that transplanting OECs into CP patients could improve the neurological function of the patients and did not cause significant side effects. The procedure may be a plausible method to treat this as yet incurable disorder.”

For anyone who saw the recent 60 Minutes report (21st Century Snake Oil) on charlatans advocating a cure through injection of stem cells (for virtually any malady under the sun), caution takes center stage with all such reports.  No – I’m not suggesting that the Chinese study is voodoo medicine by any stretch of the imagination.  For those who keep up with this field of stem cell research and its potential applicability to treatment of cerebral palsy, you are aware of the recent (early February of this year) announcement by the FDA of an approved trial for stem cell research for victims of cerebral palsy. In addition to our having reported on this FDA-approved trial, I have also reported on a collaborative research program called Newborn Possibilities Program in Arizona, which is yet another collaborative effort using stem cell research concepts to improve the lives of these children.

While hope reigns eternal that meaningful research will lead to meaningful cure or improvement in the quality of life for cerebral palsy victims, Cell Transplantation associate editor Dr. Cesar V. Borlongan offers the following words of caution concerning the Chinese (and other) stem cell clinical trial:

In parallel with recently FDA-approved US clinical trials of cell therapy for adult stroke and cerebral palsy, this clinical study in China advances the use of stem cells for treating brain disorders, but a very careful assessment of this experimental treatment needs to be exercised in order to gauge its safety and efficacy.

Through social networking media such as LinkedIn and Twitter, I have come across some fascinating people who have devoted their lives to stem cell research.  If perchance any of my ‘connections’ and ‘followers’ out there have further information about this Chinese research and other stem cell research programs involving cerebral palsy, I would greatly appreciate your sharing your information with the Nash Law Firm community of readers by posting helpful comments to this blog.

Cerebral Palsy: new research to improve dexterity by home therapy using modified gaming instruments.

Today I came across yet another interesting and common sense concept in the quest to help those with cerebral palsy for performing important dexterity exercises in the comfort of their home.  The article – Daily Targum – Researchers spawn new therapy for cerebral palsy patients – recounts a small study (3 teenage patients) taking place over the last year at Rutgers University and Indiana University using a modified Sony PlayStation 3 gaming glove to improve dexterity for victims of cerebral palsy.  

One of the keys in this research project is to find a way to move therapy into the patient’s home utilizing an activity that all kids enjoy – gaming.  The basic goal is to not only move important therapy into the home but to provide a method for young cerebral palsy patients to perform this therapy without the need of costly and time-contrained supervision.

The program is the product of a collaborative effort of these universities headed by Grigore Burdea, a University professor of electrical and computer engineering, and Moustafa Abdelbaky, an electrical and computer engineering graduate student.  Another key player in this endeavor is Meredith Golomb, an associate professor of neurology at Indiana University School of Medicine.  She found out about Burdea’s work through the Internet and said the combination of her skills with Burdea’s was perfect.

“I’m a pediatric neurologist and know how to assess the kids medically,” Golomb said. “He is an engineer and knows how to get the systems working — it has been a great collaboration so far.”

Some weeks ago, I posted a story about research underway at the University of Michigan in the use of a treadmill to help improve the neuromotor development of younger children with cerebral palsy.

It is through the work of such researchers and many others devoted to helping discover the causes of cerebral palsy that key progress in making the lives of these people with special needs better will be made.  We will  keep you posted on similar studies and research efforts.  Hopefully, if you are the parent of a child with cerebral palsy, you will find one of these techniques of interest and potentially useful in maximizing the chances of a better life for your child.

CDC Features – Data Show 1 in 303 Children Have Cerebral Palsy

Cerebral palsy – how common is it? A recent “Features” posting by the CDC (Centers for Disease Control and Prevention) provides some answers and gives parents some ‘early signs’ of which to be aware.

While everyone knows that cerebral palsy (CP) can be a devastating condition, it is less well-known how common CP actually is. The Center for Disease Control recently released new data on the frequency of CP. In its study, it found that CP affects 3.3 per 1,000 eight-year-old children, or 1 in 303 children. This data was collected from select communities in Georgia, Alabama and Wisconsin, not the nation overall. Rates may differ slightly in other localities. However, the CDC pointed out that its most current findings on CP frequency were similar to previous studies which showed that CP affected 3.6 per 1,000, or 1 in 278 children.  

In reporting the data, the CDC also advised parents what to look out for in terms of signs of CP, based on the age of the child. Parents should consult a physician if they notice any of the following signs:

A child over 2 months with cerebral palsy might have difficulty controlling head when picked up, or have stiff legs that cross or “scissor” when picked up;

A child over 6 months with cerebral palsy might continue to have a hard time controlling head when picked up, or reach with only one hand while keeping the other in a fist;

A child over 10 months with cerebral palsy might crawl by pushing off with one hand and leg while dragging the opposite hand and leg, or not sit by himself or herself;

A child over 12 months with cerebral palsy might not crawl, or not be able to stand with support;

A child over 24 months with cerebral palsy might not be able to walk, or not be able to push a toy with wheels.`

Parents, be aware of these early signs!  If you are not sure what to do or to whom you can turn, the CDC offers the following information:

To find out who to speak to in your area, contact the National Dissemination Center for Children with Disabilities by calling 1-800-695-0285 or visiting the Center’s Web site

Of course, you always have your child’s pediatrician as a starting point.

Asthma – How to Protect Your Child When the Steroid Inhaler Fails

According to an article published by WebMD, a new study by the National Institute of Health examined the effectiveness of step-up asthma treatment among children who continue to experience asthma attack on steroid inhalers.

Researchers concluded that the success of the step-up treatment varies depending on the population of children. The study focused on 182 children between the ages 6 and 17. All of the children enrolled in the study experienced asthma attacks despite regular steroid treatment. In this population, the following drugs were used: long-acting beta-agonists (LABAs), leukotriene-receptor antagonist (LTRA), and increased doses of inhaled steroids. According to the article:

The drugs with the best chance of success – 45% – are long-acting beta-agonists (LABAs)… . But safety concerns limit the use of these agents, the best known of which are Serevent and Foradil and the combination products Advair and Symbicort. About 30% of kids, the study found, do best either with a leukotriene-receptor antagonist (LTRA, brands include Accolate, Singulair, and Zyflo) or by doubling the dose of the child’s current inhaled steroid medication.

Although the study did not reveal a clear winner, researchers were able to identify the following correlations:

Hispanic and non-Hispanic white children were most likely to have the best response to LABA and least likely to have the best response to doubling inhaled steroid dosage. Black children were equally likely to have the best response to LABA or doubling inhaled steroids and less likely to have the best response to LTRA. Children who did not have eczema were most likely to have the best response to LABA.

Contributing author: Jon Stefanuca

Infant Deaths Prompt CPSC Warning About Sling Carriers for Babies

The Consumer Product Safety Commision (CPSC) has posted a warning about infant sling carriers, due to at least 14 deaths associated with the product.  The warning, posted in a release by the CPSC on March 12th, contains illustrations of the different positions, many of which are dangerous, of how babies are known to be carried in sling carriers.  The release also which infants are most at risk, as well as how to protect a child should the caregiver choose to use a sling carrier:

Many of the babies who died in slings were either a low birth weight twin, were born prematurely, or had breathing issues such as a cold. Therefore, CPSC urges parents of preemies, twins, babies in fragile health and those with low weight to use extra care and consult their pediatricians about using slings.

CPSC recommends that parents and caregivers make sure the infant’s face is not covered and is visible at all times to the sling’s wearer. If nursing the baby in a sling, change the baby’s position after feeding so the baby’s head is facing up and is clear of the sling and the mother’s body. Parents and caregivers should be vigilant about frequently checking their baby in a sling.

The CPSC has now added slings to products that require a mandatory standard.  Because time is of the essence, the CPSC is working with ASTM International to attempt to put voluntary standards in place for infant sling carriers, as soon as possible.  The release also has a link for reporting infant sling carrier problems: www.cpsc.gov/cgibin/incident.aspx.

Zarontin – The First-Line of Treatment for Children with Absence Epilepsy

According to an article published in WebMD, researchers found that Zarontin, one of the oldest drugs used to treat epilepsy, is also one of the most effective drugs to treat this condition. The research study was published in the New England Journal of Medicine.

As many as 17% of children with epilepsy have absence seizures, also known as petit mal seizures, which involve brief but frequent staring spells that can occur dozens or even hundreds of times a day. These children do not have the convulsions typically associated with epilepsy, but they are at high risk for developing them later in life. During the 10- to 15-second seizure episodes, people with absence epilepsy become unresponsive and may stop walking or talking in mid-sentence. Children with these seizures often perform poorly in school.

Zarontin is the trade name of the anticonvulsant drug Ethosuximide. Ethosuximide is also known as Emeside. In addition to Ethosuximide, a physician’s other options include Valproic Acid and Lamotrigine. The study examined the efficacy of these drugs in treating absence epilepsy.

Lamictal was found to be significantly less effective than Zarontin or Depakote for preventing absence seizures, while treatment with Depakote was more likely to result in concentration problems than treatment with the other two drugs.

Moreover, Zarontin was found to have less of an impact on a child’s concentration and attention. If your child has absence epilepsy, be mindful that the newest and most expensive anticonvulsant on the market may not be your best option. Study co-author Shlomo Shinnar, MD, PhD, of New York’s Montefiore Medical Center noted:

Unless there are reasons not to use it, Zarontin would certainly be my first-line choice.

Contributing author: Jon Stefanuca

New Research : Treadmill may help tots with neuromotor delays (such as cerebral palsy) walk

While the study group was a small one (15), researchers at the University of Michigan’s School of Kinesiology have reported supervised treadmill walking may help children with neuromotor delays.   This study was reported yesterday in an article published in The Hindu.

Rosa Angulo-Barroso, Associate Professor of movement science  at the School, and her colleagues followed 15 infants at risk for neuromotor delays over a period of two years.  They tested the changes in physical activity and treadmill-stepping performed with parental supervision in the children’s  homes.   Six of these children had been diagnosed with cerebral palsy.

“We found that in those with neuromotor delays, the pattern of development through time was parallel (but less) than normal kids.” said Angulo-Barroso. “We also found less toe-walking, so foot placement improved.” Angulo-Barroso added. The study also suggests a critical intervention window. Both children without a diagnosis and kids with cerebral palsy improved the most between 10 months and 18 months.

As The Hindu article notes, “The study, “Treadmill Responses and Physical Activity Levels of Infants at Risk for Neuromotor Delay” appears in the journal Pediatric Physical Therapy.

It would be most interesting to see if a larger, multi-center, double-blind  study could produce the same or similar results.  I haven’t personally seen the ‘tot’ version of a treadmill, but a quick search on Google images does show some interesting devices (see picture on left).  As researchers in the etiology and treatment of cerebral palsy keep working, the efforts of others such as reported here will potentially provide a wonderful interim measure toward helping these kids with special needs.  We’ll try to keep an eye on this story and will report should more information become available.

AMERICAN ACADEMY OF PEDIATRICS Policy Statement: Prevention of Choking Among Children

Hot Dogs…we love to eat them.  Many would argue eating hot dogs is an American Tradition.  Now, the American Academy of Pediatrics (AAP) is issuing a warning that hot dogs are a food choking hazard in small children.  Yesterday, February 22nd, the AAP published a Policy Statement regarding such choking hazards, through the AAP’s Committee on Injury, Violence, and Poison Prevention.  The AAP has already made some broad-sweeping recommendations in regard to preventive measures and warnings.  Some of their recommendations are quoted below from their Policy Statement:

The US Consumer Product Safety Commission (CPSC) should increase efforts to ensure that toys that are sold in retail store bins, vending machines, or on the Internet have appropriate choking-hazard warnings; work with manufacturers to improve the effectiveness of recalls of products that pose a choking risk to children; and increase efforts to prevent the resale of these recalled products via online auction sites. Current gaps in choking-prevention standards for children’s toys should be reevaluated and addressed, as appropriate, via revisions to the standards established under the Child Safety Protection Act, the Consumer Product Safety Improvement Act, or regulation by the CPSC.

The existing National Electronic Injury Surveillance System–All Injury Program of the CPSC should be modified to conduct surveillance  of choking on food among children. Food manufacturers should design new foods and redesign existing foods to avoid shapes, sizes, textures, and other characteristics that increase choking risk to children, to the extent possible. Pediatricians, dentists, and other infant and child health care providers should provide choking-prevention counseling to parents as an integral part of anticipatory guidance activities.

Many children lose their life every year from choking on food.  The Associated Press published an article yesterday citing the horrifying statistics:

Choking kills more than 100 U.S. children 14 years or younger each year and thousands more – 15,000 in 2001 – are treated in emergency rooms. Food, including candy and gum, is among the leading culprits, along with items like coins and balloons. Of the 141 choking deaths in kids in 2006, 61 were food-related.

The article also mentions the tragic death of 4 year old Eric Stavros Adler, who died from choking on a hot dog.

The AP article cites the following as some recommendations:

Doctors say high-risk foods, including hot dogs, raw carrots, grapes and apples – should be cut into pea-sized pieces for small children to reduce chances of choking. Some say other risky foods, including hard candies, popcorn, peanuts and marshmallows, shouldn’t be given to young children at all.

Something as simple as making lollipops flat like a silver dollar instead of round like a pingpong ball can make a big difference, said Bruce Silverglade, legal affairs director at the Center for Science in the Public Interest, which also has lobbied for more attention to choking prevention.

Please, please, please…make sure your children are ‘eating safely’.  Supervise your children when they are eating.  Our precious little ones are irreplaceable.  Don’t allow the shape and/or size of food to pose a life and death situation for you and your loved ones.