by Melissa Jenco · News Content Editor American Academy of Pediatrics News
Codeine and tramadol should not be used to treat pain or cough in children younger than 12 years as they could be fatal, the Food and Drug Administration (FDA) said Thursday.
The FDA unveiled several changes to the labels of the medications to protect children, adolescents and infants being breastfed.
“We are requiring these changes because we know that some children who received codeine or tramadol have experienced life-threatening respiratory depression and death because they metabolize (or break down) these medicines much faster than usual (called ultra-rapid metabolism), causing dangerously high levels of active drug in their bodies,” Douglas Throckmorton, M.D., deputy center director for regulatory programs in the FDA’s Center for Drug Evaluation and Research, said in a statement.
The FDA is adding the following new restrictions to the warning labels of codeine and tramadol:
- Codeine is contraindicated to treat pain or cough, and tramadol is contraindicated for treating pain in children under 12.
- Tramadol is contraindicated for treating pain after surgery to remove tonsils and/or adenoids for children under 18. Use of codeine for this purpose was placed under the same restriction in 2013.
- Codeine and tramadol are not recommended for use in adolescents ages 12-18 who are obese or have conditions such as obstructive sleep apnea or severe lung disease.
- Mothers should not breastfeed when taking codeine or tramadol.
Since 1969, codeine has been linked to 64 cases of serious breathing problems, including 24 deaths in children and adolescents. Tramadol is not approved for pediatric use but has been tied to nine cases of serious breathing problems, including three deaths in children and adolescents, according to the FDA. There also have been cases of breathing problems in breastfed infants whose mothers were taking codeine.
In September 2016, the Academy released a clinical report Codeine: Time to Say “No” that expressed concerns about the dangers of codeine use in children and called for more formal restrictions.
The FDA recommends physicians use other medications for treating cough and pain. Officials also encouraged parents to pay close attention to the ingredients in medication they give their children and seek immediate medical attention if children taking the restricted medications experience difficulty breathing, confusion, unusual sleepiness, trouble breastfeeding or limpness.
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FDA Drug Safety Communication http://bit.ly/2or5PHZ
FDA Q&A on the use of codeine and tramadol in breastfeeding women, http://bit.ly/2pjylz2
Consumer Update: Codeine and Tramadol Can Cause Breathing Problems for Children, http://bit.ly/2pWK2b8
Healthychildren.org information for parents on the use of codeine, http://bit.ly/2ovoQrL
Childhood shyness is common and it causes concern for some parents. A child may be shy because of many reasons, such as, harsh living situations, neglected or rejected. In some cases, shyness can be disabling. Extremely shy children can find it hard to socialize at school and the longer this goes on the more reclusive they can become. Some children just need time to adjust to a new setting and they will do well in relationships and social settings. Parents can guide their children into social situations and they can learn how to interact in a successful way. Children want to be liked but sometimes are rejected by their peers. When a child is rejected it could be because of their impulsive and disruptive behavior. This can lead to a child being neglected. Which often means they are ignored, forgotten, not invited to parties, or picked last for teams. Successful socializing interactions require skills and special ways of interacting. Parents should look for these skills in their children and help develop them.
- Expressing affection
- Asking for help
- Helping others
- Comforting someone
- Doing favors
- Keeping secrets
- Sticking up for a friend
Children sometimes use food for reasons other than hunger to satisfy themselves. These reasons may be in response to their emotions or feelings. Many things can trigger hunger such as:
One way to keep your child from eating out of boredom is to steer them towards activities that keep them busy. Also make sure your child eats three well-balanced meals and one snack each day.
A few things to do instead of eating would be:
- walk the dog
- walk around the neighborhood
- kicking a ball around
- painting a picture
- running through sprinklers
Here are ways to show your child how much you love them on Valentine’s Day or every day.
- Use plenty of positive and encouraging words with your child.
- Make an extra effort to set a good example about how to connect and talk with other people at home and in public.
- Respond promptly and lovingly to your child’s physical and emotional needs
- When your child is angry, grouchy, or in a bad mood, give him a quick hug, cuddle, pat, secret nod or other sign of affection he responds to and then consider talking with him about it when he’s feeling better.
- Use non-violent forms of discipline.
- Make plans to spend time alone with your young child or teen doing something she enjoys on a regular basis.
- Mark family game nights on your calendar so the entire family can look forward to having ways to enjoy spending time together.
- Consider owning a pet, if possible. Having a pet can help make some children, especially those with chronic illnesses and disabilities, feel better by increasing their physical activity, enhancing their overall feelings, and offering another way to connect with someone they care about.
- One of the best ways to have your child learn more about good food choices is to encourage him to cook with you.
- As your child grows up, she’ll spend most of her time improving upon a variety of skills and abilities that she gains in all areas of her life.
- Your child’s health depends a lot on the care and support you offer during his early years.
- Help your child foster positive relationships with friends, siblings and members of the community.
- One of your most important gifts as a parent is to help your child develop self-esteem.
- Don’t forget to say, “I love you” to children of all ages!
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Parents of newborn babies are presented with so much information during their brief hospital stay, it may be hard to absorb and remember it all. One of the topics usually discussed is safe sleeping for babies. We thought it would be a good idea to review that subject briefly since it is so important to your infant’s well being.
Though rare, “crib death”, or Sudden Unexplained Infant Death (SUID) as it is now called, continues to occur, causing unspeakable tragedy for the families involved. This terrible occurrence is not completely preventable, but the risk can be significantly reduced with the tips presented below.
The list of suggestions was developed by the Arkansas Children’s Hospital Injury Prevention Center and reflects the latest scientific research on what works to reduce a baby’s risk of dying in his/her sleep. If you have questions on this subject, feel free to bring them up during your next wellness appointment.
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- The safest place for your baby to sleep is in a room with you, but in his own safety-approved crib or bassinet.
- Do not allow adults or other children to share a bed with a baby.
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- Cribs should be approved by the Juvenile Products Manufacturers Association.
- The space between bars should be less than 2 3/4 inches(about the width of a soda can).
- A crib should have a firm mattress and a snug-fitting bottom sheet.
- Do not place stuffed animals, soft bedding, pillows, bumper pads, or wedges in the crib.
- Place the crib in an area that is always smoke-free.
- Be sure any secondhand crib has not been recalled. Visit www.recalls.gov. Make sure any crib has all its parts.
- Do not allow your baby to sleep in a car seat if it’s not in a vehicle.
- Do not use bouncy seats, sofas/chairs as a sleeping arrangement for your baby.
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- Side sleeping is not safe and is not advised.
- Babies sleep comfortably on their backs.
- Babies are less likely to choke when they sleep on their backs.
- Babies need adult-supervised “tummy time” when they are awake. This helps them develop normally and helps prevent flat spots on their heads.
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- Overheating is a risk factor for Sudden Infant Death Syndrome.
- Dress the baby in the type of clothes you would be comfortable wearing.
- Blankets can become loses and end up on the infants face. Instead of using blankets, dress your baby in a wearable “sleep sack”.
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- Get all recommended immunizations.
- Keep the baby away from cigarette and other smoke.
Mumps has been in the headlines lately, and for a good reason. We are in the midst of a significant outbreak in several areas of our state, and cases of mumps have recently shown up in Northeast Arkansas. Here are a few facts about this disease:
- Mumps is a viral illness spread by coughing and salivary contact. It is present throughout the world and is uncommon in the USA because we immunize for it. The virus infects our respiratory tract and salivary glands, lasts for several days, and usually resolves without complications. After a 2-3 week incubation period, children and adults typically develop cough and congestion, sometimes fever and headache, and about two thirds have salivary gland inflammation with tender, firm swelling over one or both cheeks. When it is suspected, mumps can be tested with a cheek swab – the result may take several days.
- Thought the disease is usually relatively mild and self-limited, it can cause occasional severe complications including swollen testicles in adolescent or adult males, viral meningitis, encephalitis, arthritis, or other glandular inflammation. For women in early pregnancy, there may be a slight increased risk of spontaneous miscarriages.
- There is no specific treatment for mumps, so the only effective approaches are containment and prevention. Infected children can pass on the virus well before, and for about 1 week after the symptoms show up, so isolation of sick or highly susceptible individuals is important. Mumps vaccine is part of every child’s routine immunization regimen and is usually given at 1 and 4 years of age. Most, but not all children who’ve had both doses are fully immune.
More information, including detailed isolation advice, is presented in a recent Arkansas Department of Health Newsletter (see below), and you may feel free to contact us if you have questions or concerns.
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Effective NOW, the Children’s Clinic will offer Walk-in clinic hours Monday-Friday, 8:00 AM – 6:00 PM and Saturday, 9:00 AM-2:00PM.
We are proud to offer a Walk-in clinic as an extra level of service and convenience because we know it is especially helpful for families with busy schedules. For common straightforward health issues, just bring your child to our walk-in clinic and you won’t have to worry about making and keeping an appointment later in the day or the following day.
The Children’s Clinic’s vaccine policy remains unchanged. As pediatricians, we strive to maximize health and minimize illness. We do take advantage of opportunities both big and small, as they present themselves and educate families about the importance of vaccines. Immunizing is vital to protecting us all, but especially the most vulnerable among us.
Our clinic doors will be locked at 6:00pm on Monday – Friday and 2:00pm on Saturday.
How does the Walk-in clinic work?
No appointment is necessary. If you choose to walk-in, you will NOT be able to select the provider you want to see. You will be placed in the first available exam room. If you have a concern and would like to see your primary provider, please call our office to schedule that appointment.
When you arrive and decide you do not want to see the provider who is working the walk-in clinic that day, one of two things may happen:
1. If there is an available appointment with a different provider, we will let you know and you can make the decision on whether to see them or not.
2. Or, you can make an appointment for a different date with the provider of your choice.
What types of issues can be seen in the walk-in clinic?
Walk-in visits are for ACUTE issues such as: ear infections, rashes, sore throats, eye problems, bug bites, bumps and scrapes, urinary tract issues, upper respiratory issues, cough, fever and minor trauma.
However, the walk-in clinic is NOT for chronic or wellness issues such as medication refills, well visits, sports physicals, immunizations, ADD/ADHD, Asthma, headaches, back pain, etc.
Does the walk-in clinic have a long wait?
Our walk-in clinic wait time does vary throughout the day, week, and season. It is one of our top priorities to not leave patients waiting any longer than necessary.
Based on experience, we know there will be “rushes” throughout the day. Those are typically, 8:00 AM– 9:00 AM and 4:30 PM-6:00 PM.
Do I sign in at a different place for walk-in clinic?
No, you will sign in at our receptionist desk on the 4th floor.
Address: 800 South Church, Suite 400, Jonesboro, AR
(corner of Church Street and Matthews)
What makes our walk-in clinic different than others?
We have 7 Board Certified Pediatricians and 3 Advanced Practice Nurses who will rotate through our walk-in clinic.
Our walk-in clinic is a great service we are providing for our established patients. If you have previously been dismissed from our practice, you will not be able to utilize our walk-in clinic.
If your child does not have a pediatrician, please call our office at 870-935-6012 to inquire about establishing with our practice.
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Bring your health insurance card to every visit at our walk-in clinic. And, be prepared with your current address, email address, phone number, emergency contact number and child’s Social Security Number.