Nationwide Children's Hospital : Bunk beds pose dangers to kids and adults

(COLUMBUS, Ohio) – Bunk bed-related injuries are not an issue of concern solely for parents of young children according to a study conducted by investigators at the Center for Injury Research and Policy of The Research Institute at Nationwide Children’s Hospital. The study, published in the June issue of Pediatrics, found although three-quarters of the children who sustain bunk bed-related injuries are younger than 10 years of age, there is a surprising spike in injuries among individuals between the ages of 18 and 21 years.
The study is the first of its kind to use national data to comprehensively examine patterns and trends of bunk bed-related injuries among children and young adults (up to 21 years of age). There were an estimated 572,580 bunk bed-related injuries during the 16-year study period, resulting in an average of nearly 36,000 cases annually.
“The high rates of injury found in our study suggest the need for increased prevention efforts to lower the risk of bunk bed-related injury, especially among young children and young adults,” said study co-author Gary Smith, MD, DrPH, director of the Center for Injury Research and Policy at Nationwide Children’s Hospital, and an associate professor of Pediatrics at The Ohio State University College of Medicine.
Bunk bed-related injuries occur most frequently among males, and half of the cases analyzed involved children younger than 6 years of age. Bunk bed injuries most commonly result from falls. The most common bunk bed-related injuries include lacerations, contusions/abrasions and fractures. While fractures were the third most common injury, patients with fractures were almost six times more likely to require hospital admission, transfer to another hospital, or to be held for observation.
The body regions most frequently injured include the head/neck and face. Injuries to this area of the body are especially common among small children who, due to a higher center of gravity, tend to fall head first. Children less than 3 years of age were 40 percent more likely to sustain head injuries than older children.
The study also found 18- to 21-year-olds experienced twice as many injuries as adolescents in the 14- to17-year-old age group. The reason for this finding is unknown, however, individuals in this age group may use bunk beds more frequently due to increased residence in institutional settings, such as college dormitories and the military. Older children were also found to be significantly more likely to be injured due to bed malfunction than younger children, perhaps due to their larger size and increased weight.
“Everyone wants to feel safe and secure while resting or sleeping, yet bunk beds are a common source of injury among children and adolescents,” said study co-author Lara McKenzie, PhD, MA, principal investigator in the Center for Injury Research and Policy at Nationwide Children’s, and an assistant professor at The Ohio State University College of Medicine. “Our study found that bunk bed-related injuries can be severe and require hospital admission. In addition to children less than 6 years of age, young adults have a significantly increased risk of injury from bunk beds in schools, recreational sports facilities and public properties.”
Recommended strategies for prevention of bunk bed-related injuries include making sure guardrails are used on both sides of the upper bunk, with guardrail gaps being 3.5 inches or less to prevent entrapment and strangulation; ensuring the mattress foundation is secure and the proper size mattress is used; not permitting children younger than 6 years of age to sleep in the upper bunk; discouraging children from playing on bunk beds; using night lights to help children see the ladder at night; removing hazardous objects from around the bed; and not placing the bunk bed too close to ceiling fans or other ceiling fixtures. Bunk beds should not be changed so as to negate safety standards.
###
Data for the study were obtained from the National Electronic Injury Surveillance System of the United States Consumer Product Safety Commission. The analysis included cases of non-fatal bunk bed-related injuries treated in emergency departments across the U.S. from 1990 through 2005.
The Center for Injury Research and Policy (CIRP) of The Research Institute at Nationwide Children’s Hospital works at the local to international levels to reduce death and disability due to injuries through research, education, advocacy and advances in clinical care. CIRP aims to improve the scientific understanding of the epidemiology, prevention, acute treatment, rehabilitation and biomechanics of injuries. CIRP educates health and other professionals, policy makers and the public regarding the importance of injuries, injury research and injury prevention. CIRP provides leadership in the development, implementation and scientific evaluation of public policy regarding control of injuries. Learn more about CIRP at http://www.injurycenter.org/.

Hopkins Children's research shows from breastfeeding boys benefited more then girls

Gender differences illuminate new strategies for future therapy
Challenging the long-standing belief that breast-feeding equally protects all babies against disease, research led by Johns Hopkins Children's Center investigators suggests that when it comes to respiratory infections, the protective effects of breast milk are higher in girls than in boys.
Following 119 premature babies in Buenos Aires through their first year of life, researchers found that breast-feeding not only offered more protection to girls than boys, but also that formula-fed girls had the highest risk for severe respiratory infections.
The findings, reported in the June issue of Pediatrics, cast doubt on the theory that immune system chemicals contained in breast milk and passed directly from mother to newborn are responsible for preventing the infections. If this were the case, researchers say, both boys and girls would likely derive equal protection.
In addition, breast-feeding did not appear to affect the number of infections, but rather their severity and the need for hospitalization, meaning that breast milk does not prevent a baby from getting an infection, but helps a baby cope with an infection better.
"In light of these results, we are starting to think that milk does not directly transfer protection against lung infections but instead switches on a universal protective mechanism, already in the baby, that is for some reason easier to turn on in girls than in boys," says senior investigator Fernando Polack, M.D., an infectious disease specialist at Hopkins Children's.
Shortly after birth, formula-fed girls were eight times more likely than breast-fed girls to develop serious respiratory infections requiring hospitalization, the study results showed. Formula-fed girls were also more likely to develop such infections than both breast-fed and non-breast-fed boys.
The findings, researchers say, are particularly important for healthcare in developing countries, where antibiotics and other treatments are scarce and where an estimated one-fourth of premature babies end up in the hospital with severe respiratory infections.
"When resources are limited, it helps to know that your high-risk group is formula-fed girls," Polack says. The findings also suggest that the mothers of premature girls should be strongly encouraged to breast-feed, investigators say.
In the United States, by contrast, drugs are readily available to prevent complications and hospitalizations are less frequent. However, researchers point out, because these drugs protect against only two of many respiratory viruses and are expensive, mothers should breast-feed both girls and boys when possible. Despite gender differences in the levels of protection against respiratory illness, researchers say that breast-feeding remains the best nutrition for both full-term and premature infants, regardless of sex, and that breastfeeding's benefits extend to brain development and general health.
For the study, investigators tracked responses to a first infection after birth and found that breast-fed girls were the least likely to be hospitalized with an acute respiratory disease. Only 6 percent (two of 31) of breast-fed girls had first infections severe enough to require hospitalization compared to 50 percent (12 out 24) of the non-breast-fed girls. There was virtually no difference in hospitalization for first infection in breast-fed versus non-breast-fed boys, with 18 percent from both the breast-fed and non-breast-fed groups developing severe respiratory infections. This pattern repeated itself throughout the first year of life and in subsequent infections, with breast-fed girls showing fewer complications and hospitalizations than both formula-fed girls and breast-fed and formula-fed boys. In the first year of life, formula-fed girls continued to have the highest risk for severe respiratory disease and hospitalization.
If breast milk does indeed trigger a universal - but variably activated - protective mechanism against multiple viruses, the next step is to figure out exactly how this mechanism gets switched on and why it is relatively harder to activate in boys.
"Unraveling this mechanism may one day lead to broad-based therapies that might be as effective as five or six vaccines," Polack says, because vaccines have a narrow spectrum of defense and work only against specific viruses.
###
Fundacion INFANT ran the 24-month-long study in Buenos Aires.
The study was funded by the National Institutes of Health. Other Hopkins investigators in this study: Guillermina Melendi, M.D.
Other institutions in the study: The National Institute of Environmental Health Sciences, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires; Hospital de Pediatria Juan P. Garrahan, Buenos Aires; Maternidad Sarda, Buenos Aires.
Founded in 1912 as the children's hospital of the Johns Hopkins Medical Institutions, the Johns Hopkins Children's Center offers one of the most comprehensive pediatric medical programs in the country, treating more than 90,000 children each year. U.S. News & World Report ranks Hopkins Children's among the top three children's hospitals in the nation. Hopkins Children's is Maryland's only state-designated Trauma Service and Burn Unit for pediatric patients. It has recognized Centers of Excellence in 20 pediatric subspecialties including cardiology, transplant, psychiatric illnesses and genetic disorders. For more information, please visit: www.hopkinschildrens.org

keep kids in school infection control intervention helps

Disinfecting and using hand sanitizers helped reduce absenteeism rates in elementary schools
BOSTON, June 2, 2008 – A study from researchers at Children's Hospital Boston published in Pediatrics found that a simple infection control intervention in elementary schools – disinfecting frequently-touched surfaces and using alcohol-based hand sanitizers – helped reduce illness-related student absenteeism.
Illnesses caused by bacteria and viruses account for millions of lost school days each year.(1) According to Thomas Sandora, MD, MPH, a pediatric infectious diseases specialist at Children's Hospital Boston, "The best ways to avoid common infections are cleaning your hands and preventing exposure to the germs that cause these illnesses. Our research indicates that elementary schools should consider a few simple infection control practices to help keep students healthier."
The study, led by Dr. Sandora, was a randomized, controlled trial involving 285 third-, fourth-, and fifth-grade students in an elementary school system in Avon, Ohio. Teachers in intervention classrooms used disinfecting wipes on student desks, and students used hand sanitizer in the classroom at key points throughout the school day. Control classrooms followed usual hand washing and cleaning procedures.
Over eight weeks, researchers tracked the frequency of absences and the reasons for missing school. Study investigators also tested several classroom surfaces for total bacterial counts and for the presence of several common viruses.
Researchers found absenteeism rates for gastrointestinal illnesses were nine percent lower in classrooms that followed the infection control regimen of disinfecting surfaces and using alcohol-based hand sanitizers. The absenteeism rate for respiratory illness was not affected by this intervention.
Gastrointestinal illnesses are extremely common for school-age children, and children can be at risk for these infections because of frequent exposure to ill peers and poor hand hygiene.(1) In fact, the bacteria and viruses that cause these gastrointestinal infections can be easily passed from one person to another on the hands.(2) The germs can also survive on surfaces in the environment, where some of them can persist for hours to days.(1)
The study suggests that schools should consider adopting simple infection control practices, including disinfecting desktops once a day and using hand sanitizer before and after lunch, to help reduce days lost to common illnesses.
###
The study involved a single elementary school system (classrooms located in two buildings) located in Avon, Ohio. Study funds, hand sanitizer and disinfecting wipes were provided by The Clorox Company (Oakland, Calif).
Children's Hospital Boston is home to the world's largest research enterprise based at a pediatric medical center, where its discoveries have benefited both children and adults since 1869. More than 500 scientists, including eight members of the National Academy of Sciences, 11 members of the Institute of Medicine and 12 members of the Howard Hughes Medical Institute comprise Children's research community. Founded as a 20-bed hospital for children, Children's Hospital Boston today is a 397-bed comprehensive center for pediatric and adolescent health care grounded in the values of excellence in patient care and sensitivity to the complex needs and diversity of children and families. Children's also is the primary pediatric teaching affiliate of Harvard Medical School. For more information about the hospital and its research visit: www.childrenshospital.org/newsroom.
(1) http://www.itsasnap.org/snap/references.asp#6 (2) http://www.cdc.gov/ncidod/dvrd/revb/gastro/faq.htm
Bess Andrews, Children’s Hospital Boston 617-919-3110 elizabeth.andrews@childrens.harvard.edu
Leslie Schrader, Ketchum 202-835-7278 leslie.schrader@ketchum.com