The American Academy of Pediatrics has offered revised recommendations regarding children’s intake of fruits and fruit juice. If you’re wondering why such a thing is necessary, think no further than avoiding a lifetime of bad teeth and reducing the risks of childhood obesity and failure to thrive. The recommendations are adjusted by age, but the most fundamental consideration is parents should age giving any fruit juices during the first year of a child’s life. In short, it’s time to toss the sippy cup. Here are the recommendations: Birth to Age 1:
Breast milk or formula should be the only nutrient fed to infants for the first six months of life.
After six months of age, parents can introduce fruits (either mashed or pureed) but not fruit juice.
At this age, children need one cup of fruit a day.
Up to 4 ounces (half a cup) can come from 100% fruit juice.
At this age, focus on whole fruits.
Fruit juice shouldn’t exceed 4-6 ounces a day.
At this age, children and teens should get 2 to 2.5 cups of fruit daily.
Fruit juice shouldn’t exceed 8 ounces (1 cup) a day.
This past week, the Centers for Disease Control and Prevention (CDC) released new draft recommendations for healthcare providers on parental and patient counseling on the decision on whether to circumcise. This Straight, No Chaser reviews those recommendations and the logic behind it. It is of note that these recommendations are a step away from prevailing medical thought.
As a medical professional, circumcision has long been one of those things that has made me go hmmm…. If your religious beliefs include this as a ritual or ceremony, fine. I get it, and I have no criticism at all. No disrespect is intended. Otherwise, circumcision has largely been a procedure looking for an indication. Quick, tell me what other elective surgical procedure or harmful activity of any type is allowed on children, much less newborns? While I’m waiting for you to think about an answer that doesn’t exist, let’s recap the procedure and the medical logic behind it.
As you know (and many men are painfully aware – pun intended), circumcision is the surgical removal of the skin over the glans (tip) of the penis. Over the last 30 years, the rate of males receiving the procedure has dropped from 64.5% to 58.3%, according to the National Center for Health Statistics. Worldwide about 30% of males are circumcised, and of those receiving it, the religious influence is largely present. 69% of those being circumcised are Muslim and 1% are Jewish (Circumcision is part of religious rituals in both religions).
Let’s cut to the chase (no pun intended): Here are the best arguments for circumcision.
It helps prevent certain infections (e.g. yeast and UTIs – which most males aren’t especially prone to anyway).
The cells of the inner surface of the foreskin may provide an optimal target for the HIV virus (This is theoretical and not conclusively decided in the medical literature. In any event, this is NOT the same as saying uncircumcised males do or are more likely to contract HIV.). Even more importantly, this is NOT the same as saying uncircumcised males fail to be sufficiently protecting by use of condoms and other means of safe sex.
Circumcised males have a lower rate of penile cancer (which is very low under any circumstances).
Now, there are emergency indications for circumcision, but that really isn’t the topic of discussion here. The one I’ve had to address (twice in twenty years) is an inability to readjust a foreskin that too tightly adhered to the shaft of the penis (paraphimosis). Obviously, that’s a medical emergency and not something frequently seen enough to justify universal circumcision any more than a much higher rate of appendicitis would warrant universal and elective removal of everyone’s appendix.
Here are criticisms of the decision to have circumcision.
Any surgical procedure has complications, and that should be taken seriously. That said, the complication rate for circumcision is very small and includes bleeding infection and pain.
Circumcision is a violation of a child’s body and is unnecessary and disfiguring. The foreskin might not be cut the appropriate length, might not heal properly and may require addition surgery because the remaining foreskin incorrectly attaches to the end of the penile shaft.
Honestly, both the risks and benefits are quite overstated, with exceptions for certain parts of the world with exceedingly high HIV rates. Circumcision doesn’t appear to be a medically necessary procedure, but it isn’t an especially dangerous one. Interestingly, the American Academy of Pediatrics’ latest comment on circumcision is that the benefits of circumcision outweigh the risks, which stops short of recommending routine circumcision for all. Even that equivocal smacks of conflict of interest, given who’s performing the procedure at a significant cost to the consumer. Again, this appears to be a procedure looking for an indication – but… The CDC appears to be going agains the grain with its latest comments. Their new message is pretty clear: the benefits of the procedure — including reducing one’s risk of acquiring HIV, herpes virus, and human papillomavirus — outweigh the harms. They even go as far as to suggest that adolescents and adult males consider the procedure. Of course, it must be said that the CDC’s focus is on the prevention and control of disease, as opposed to the American Academy of Pediatrics, whose focus is children and their health. This is a subtle yet important decision while likely has played out in the extra consideration given by the CDC. If I was having this conversation in Africa, where the sexually transmitted infection rate is substantially higher and can be significantly reduced by circumcision, I’m sure I’d be more firmly on board with circumcision. If my Jewish or Muslim friends and colleagues were asking my medical advice on the safety of getting the procedure done as part of their religious ceremonies, we’d be having a different conversation. However, we’re not, and for the population in general, it’s safe to say that – various preferences (for various reasons) aside – there’s no compelling reason to recommend circumcision on all newborn males. It just feels like a recommendation to do so is giving in to the notion that we can’t be trusted to have safe sex.
So I’m back in the emergency room with a little girl who looks like her forearm is going to fall off the rest of her upper extremity. People love trampolines. Yet somehow the only time I seem to hear the word trampoline is when someone’s been hurt. I’m not the only one who’d vaporize them on site. The American Academy of Pediatrics recommends that trampolines never be used at home or in outdoor playgrounds because these injuries include head and neck contusions, fractures, strains and sprains, among other injuries.
So my patient had a (posteriorly) dislocated elbow, meaning she fell off the trampoline, landing on the back of the extended upper arm, pushing the upper arm bone (the humerus) in front of the elbow and forearm. This is how that looks.
So for the joy of bouncing on a trampoline, the child had to be put asleep so the elbow could be replaced into the appropriate position. This procedure is fraught with potential for complications, including a broken bone on the way back, as well as damage to the local nerves and arteries (brachial artery, median and ulnar nerves), which can become entrapped during the effort to relocate the bone into the elbow joint. Some limitation in fully bending the arm up and down (flexion and extension) is common after a dislocation, especially if prompt orthopedic and physical therapy follow-up isn’t obtained. This really is a high price to pay for the privilege of bouncing up and down. So if you’re going to allow your kids to play on a trampoline, here are two tips shown to reduce injuries.
Find one of those nets that enclose the trampoline, and make sure the frame and hooks are completely covered with padding. This is meant to protect against getting impaled, scratched or thrown from the trampoline.
Keep the trampoline away from anything else, including trees and rocks. This works even better if the trampoline is enclosed as previously mentioned.