Cardiac screening for 6th graders

After two adolescents died of heart attacks last year in Houston, a doctor screened 94 6th graders at a local middle school. He found 7 with undiagnosed heart problems, including two that needed surgery to correct. They have ramped up to screen 1500 kids, and, as one might expect, they are pushing for universal screening of 6th graders for heart problems.

This is interesting from a health-care-cost perspective. We have to weigh the monetary and resource-use cost of giving all 6th graders a physical exam, electrocardiogram, and echocardiogram against the psychic and loss-of-production costs of the deaths of two kids a year in a city the size of Houston. The 2% who needed surgery would increase immediate health-care costs, but they might reduce chronic problems (and costs) later.

But one wonders why 6th grade is the magic place to start screening. If  kid has a hole in her heart at age 12, she probably had it at age 3 and would have had a lot more energy in the ensuing 9 years if it had been taken care of earlier.

Injury rates in child care compared to home

Researchers in Britain looked at accidental injury rates in 18,114 kids age 9 months and 13,718 kids age 3 years in relation to the type of care the kid got, formal child care, informal child care, or only parental care, and family income.

If you look at child care overall, there is no association between child care type and accidental injury rate. But if you separate it by income and age, there is.

• At 9 months, poor kids had more injuries if they were in child care compared with just a parent. Rich kids had fewer. 
• At 3 years, poor kids in informal child care still have more injuries, but formal child care is not associated with higher injuries in any economic class. 

The authors don't speculate on why this is, but I will. Another way of phrasing the findings is that rich infants are injured more when their moms don't have respite care, but when they do send them to formal child care, they can pay for good care (eg low ratios). No, that's unfair. They're right. We should just figure out why all this is.

Coughing on a baby and rubbing it in

A few days ago I posted about the medical recommendation to cough into your elbow instead of your hand. I thought that would brush the virus off onto whatever your sleeve touches. I mentioned hugging kids, but a commenter* added, "and I just love watching a caregiver cough into her shoulder and then pick up a baby."

Of course. Of all the things a blogger on child care thinks of that a sleeve might brush against, I forget babies. Coughing into your sleeve or shoulder and then picking up a baby is just like coughing on the baby and rubbing it in. The protocol in an infant center should be one of three procedures:

1. Cough into your shoulder or elbow.
2. Change your shirt or wash your arm.
3. Pick up baby.
   or

1. Cough into your hand.
2. Wash your hands.
3. Pick up baby.
   or

1. Cough into kleenex.
2. Throw kleenex away.
3. Pick up baby. 

*Commentaria primaria, the first commenter on this blog, may her tribe increase and her memory be revered.

UPDATE: I just looked at the Centers for Disease Control's recommendations for child care centers. It says, "cover noses and mouths with a tissue when coughing or sneezing (or a shirt sleeve or elbow if no tissue is available)."

Coughing into your sleeve

Again this morning on NPR, I heard a recommendation from a doctor that we cough into our elbows instead of our hands. The reasoning is that if we cough into our hands and then touch something, the virus can be transmitted, and this is good reasoning. The virus can stay there until we wash our hands or use a hand sanitizer.

But if you instead cough into your sleeve, the sleeve has the viruses instead of the hand, so it can transfer to anything your sleeve touches, such as the kid you hug or the notebook you cradle in your arm.

It seems to me that the best way would be to cough into a tissue and throw it way, or to cough into your hand and then wash your hands. Hands get washed much more often than elbows or sleeves.