Bambini January 2016 Newsletter 
Surge in Pediatric Myopia
According to a 2009 report in JAMA Ophthalmology, myopia rates in this country increased by 66.4% over a thirty period beginning in the 1970s. In China, myopia rates have climbed from 10-20% roughly 60 years ago to 90% today; 96% of 19 year-old men in China are now myopic. What is going on here?!
Various theories have been put forward. The ones that seem to hold the most water relates to outdoor time. It's said that only 10% of farmers wear glasses, whereas 90% of accountants need them. Moreover, a randomized clinical trial of almost 2,000 six year-olds in Guangzhou, China found that as little as 40 additional minutes of outdoor activity reduced incidence rates of myopia over the next three years.
The other factor that's suspected, of course, is all the time we spend these days looking at computer, tablet, and smart phone screens. Is it the small fonts? The backlighting? Both?
In our practice, we notice that when testing vision, most healthy kids score 20/40 at age four. By age six or seven, they're at 20/20. But then some of the more studious children start to fade.
Beside giving their kids more "green time," what else can parent do to prevent or perhaps even reverse myopia? In a study from Singapore published last year, doctors found that low dose atropine eye drops were associated with a reduction in the onset of myopia. 400 myopic children were studied and given drops at bedtime for two years. Results were assessed up to five years later.
Other more natural approaches include the Bates Method and various phytonutrients. Rather than going back for a stronger pair of lenses every couple years, consider looking into other options.
Tortle Beanie vs. Mimos Pillow
About 20 years ago, doctors in the US, based on research done in the land down under, began recommending that infants sleep on their back. While the incidence of SIDS plummeted, plagiocephaly (flat spots) rose dramatically.

One study showed an incidence of 47% at two months of age. Every year, about 3 or 4 kids from our practice end up in a helmet. Torticollis is often associated with plagiocephaly.
We'd like to see that plagiocephaly rate lower. An option that was developed in England and has been available overseas for several years is the Mimos Pillow, a breathable donut that cradles the baby's head. We see that they are now available on Amazon - a bit pricey at $110.  Of note, the American Academy of Pediatrics recommends against pillows of any type.   
More recently, a parent brought another option to our attention called the Tortle Beanie. Developed by a neonatologist, this hat has a little wedge that can be positioned to help encourage the baby to hold her head while sleeping in such a way that plagiocephaly is less likely to develop (or perhaps treat it if caught early).  Available at stores like Target for $20, these beanies are affordable. 
Helmets must be custom-made by an orthotist, require several trips / adjustments, and can get hot to wear in summer. Have you had experience with either the Mimos Pillow or Tortle Beanie? They look like practical options to us. Share your experience or thoughts on our Facebook page once this newsletter has been posted there. 
CBD Oil for Epilepsy
With the opening of a medical marijuana dispensary in Kingston, NY by Etain Health, parents of children with chronic or severe ailments such as cancer, Crohn's, and epilepsy might be starting to wonder about this treatment option.
Indeed, some research is actually starting to trickle in on cannabidiol (CBD). In a 12-week study presented last month at the American Epilepsy Society's 69th Annual Meeting in Philadelphia, Pennsylvania., 261 patients (average age 11.8 years) were given the proprietary CBD extract Epidolex (GW Pharmaceuticals). Researchers from NYU and the University of California San Francisco reported a median 45.1% decrease in seizure frequency; 47% of patients experienced a ≥50% reduction in seizures. That's pretty impressive!
A few years back, a family from our practice actually moved to Colorado for several months to obtain Charlotte's web CBD for their infant daughter with refractory epilepsy. Despite failing treatment with conventional drugs, the little one had a dramatic response to CBD.
Of note, with certain exceptions, the American Academy of Pediatrics remains firmly against legalizing marijuana for medical use.
Custody Battles
Less than half the children in the US now are raised in traditional families. With that change has come a dramatic rise in custody battles. We are certainly seeing this in our practice.

Thankfully, most parents are respectful of our effort to maintain a neutral stance in these difficult situations.
But in some cases, allegations of abuse or neglect arise. Not uncommonly, a parent will bring a young child to the office that has recently returned from a visitation with a small, unexplained bruise or mark.

At other times, strong differences of opinion develop over immunization preference or other aspects of medical care. Finally, certain parents involved in family court have sought our opinion on emotional harm allegedly caused by the other parent.
Bambini is not staffed by forensic experts (there are some, but not many, out there). If you feel your child has been seriously abused physically or sexually after a visitation with the other parent, it is probably best to visit the local emergency room - where staff are better equipped to collect criminal evidence.

Moreover, we just do not have the time or special interest to testify in child custody cases. If we were to change our position, there would literally be no one left in the office to see kids with sore throats and earaches! Thanks for your understanding in this delicate matter.
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