It seems that fallout from the Disneyland minor measles outbreak continues... Last spring, one may recall that the NYS Department of Health issued a new mandate for children attending school or daycare. In particular, this edict increased the DPT and polio shot entry requirement.

A few days ago, a family brought a NYS Department of Education memo dated June 19th to our attention. The memo is addressed to district superintendents and school health personnel. The memo calls for broadening of the requirements for second doses of MMR and varicella vaccines. These changes are summarized here:

• This new Dept of Ed mandate has been issued only 10 weeks before school starts in September.
• It has been given no publicity. It has not been in the papers. Pediatrician offices have not been informed.
• The mandates posted by the Department of Health and the Department of Education currently (as of July 21, 2015) contradict each other!

We have already started discussing this quandary with families that have been in the office for school physicals this week. Understandably, parents are not sure what to do.

Bambini will try to have adequate stock of vaccine available in anticipation of a mad rush in September if schools actually start barring students that have not been given the second doses (or titers - the DEC memo does not address titers....).  We hope for some clarification / resolution on this matter soon!  

Purell has been with us for some 19 years now; and chemical hand sanitizers seem to be cropping up almost everywhere - starting in hospitals, we now find them in grocery stores, restaurants, and other public settings. Thoughtful parents might thus assume that they are both effective and safe. But are they?

In findings presented at the American Society for Microbiology in May 2006, researchers from Emory University showed that norovirus was effectively removed from the hands of 96% of volunteers using plain water. When an antibacterial soap was used, the virus was removed successfully in 88% of volunteers -- down a notch but still pretty good. With Purell, it dropped to 46%. Yikes!!

In May of this year, the FDA announced that it plans to take a closer look at hand sanitizer safety. Purell is about 130 proof alcohol. Obviously, it's highly flammable. At least four deaths have been reported.

Although the American Academy of Pediatrics is okay with children over age 24 months using hand sanitizers, we are not too enthusiastic about them. You won't find them in our office.

What can a family do in a pinch, say while away from home? It appears that washing your little one's hand with plain water - perhaps using a cloth that contains a few drops of essential oils such as Thieve's - would be a safer and more effective alternative.  

Last week, the New York Times published an interesting op-ed by Maxine Eichner, a professor of law at the University of North Carolina, entitled "The New Child Abuse Panic."

She cited the case of Justina Pelletier, a teen that was treated at Tufts and later at Boston Childrens Hospital for mitochondrial disease. Some of the doctors thought the symptoms were psychiatric and called in Child Protective Services.

Professor Eichner then goes on to relate an experience with her own teenage daughter, who developed a condition called POTS at age 13. Some doctors they consulted labelled the condition emotional. By age 18, she too had a diagnosis of mitochondrial disease - which was treated, and she is now in college.

This reminds us of a teen currently in our practice who, at the age of two weeks, was brought to a pediatrician with swollen arm.  X-ray showed a fracture.  Skeletal survey showed additional suspicious epiphyseal fractures.  The child and her two year-old brother were taken from the parents - who had been completely cooperative with the authorities.

Eventually, the parents had to hire a pediatric orthopedic surgeon from a major medical center who testified that the x-rays had been over-read and did not show epiphyseal fractures.

Moreover, a little known condition called "Temporary Brittle Bone Disease of Infancy" (now recognized as vitamin D deficiency) might well have been involved with the arm fracture.  The girl had been born in the spring -- when vitamin D is typically at its lowest level.   

Suspected child abuse or neglect is a very sensitive, difficult matter. We second Dr. Eichner's conclusion:

We must protect children from the rare disturbed parent. But medical child abuse, as it has been understood, is far too big and blunt an instrument to accomplish this purpose.

It has harmed too many genuinely sick kids, and made life hell for too many loving parents. It is time to end the medical abuse panic.   

What do you think?  Please share thoughtful comments on our Facebook page once this newsletter has been posted.