Region 8 EMS
Pediatric Disorders of Today
Let’s face it—EMS is a perfect fit for those of us who have a short attention span (Hey!
I’m talking here!) and need immediate gratification for our actions. We can honestly
say that we like helping people, and eagerly await the results of our interventions.
Knowing how to secure spider straps, start an IV, terminate some abnormal heart
rhythm…all of these (and many more) are skills which enable us to care for our
patients. It is equally as important to be current on events, disease conditions and
trends because sooner or later, these things will affect how we deliver patient care.
The focus of this month’s C.E. will be on two disorders affecting the pediatric
population: Autism and Obesity.
1. Define Autism and list distinctive behaviors and other symptoms
which typically characterize this disorder.
2. List developmental milestones of children, and how they relate to
assessing overall wellness of the pediatric patient.
3. State prehospital considerations when assessing/caring for and
interacting with autistic individuals.
II. Childhood Obesity
1. List factors which contribute to childhood obesity.
2. State physiologic and psychological consequences of obesity in the
3. List actions for resolution of childhood obesity.
APRIL IS NATIONAL AUTISM AWARENESS
For many, the movie “Rainman” provided the first exposure of what we know now as
autism. Certainly, the past decade has seen a rise in autism awareness. This disorder
has gotten much attention from the media, parents and the medical community. A
complex disorder affecting so many, we have seen parents and some of the world’s
most respected professionals working tirelessly to find the cause(s) of autism, and a
cure for all.
Current studies suggest the incidence of autism is 1:150 children ages 10 and
Males are affected 4x more than females
Autism is 5x as common as Down Syndrome, and 3x as common as juvenile
WHAT EXACTLY IS AUTISM?
Autism is a general term used to describe a spectrum of developmental disorders.
These are also referred to as Autism Spectrum Disorders (ASD). Autism is classified as
a “spectrum” disorder, because there is a wide range not only of the symptoms and
behaviors, but also differences in their severity. These disorders affect the child’s ability
to interact and communicate with others, and can also interfere with their ability to
learn and play. The signs and symptoms of autism typically present during the first
three years of life.
Autism is characterized by three distinctive behaviors, which can range from mild to
completely disabling. These behaviors are:
Impaired social interaction
Problems with verbal and non-verbal communication
Unusual, repetitive or severely limited activities and interests
IMPAIRED SOCIAL INTERACTION
The hallmark feature of autism is impaired social interaction, and is usually one of the
first symptoms noticed first by the parents. The onset of this symptom differs from
child to child.
Some children demonstrate impaired social interaction from infancy. These behaviors
include failure to respond to their name, or not smiling in recognition of their parents’
faces. When this occurs, many parents suspect that the child has a hearing deficit and
seek a medical evaluation. Other behaviors include fixation on one object, and
resistance to being cuddled or hugged.
A thorough hearing exam is necessary prior to diagnosing a
child with autism.
Other autistic children begin to withdraw from social interaction after a seemingly
normal developmental period. Imagine what this must be like for these parents. Many
parents will comment that their normally happy, and interactive child “disappeared.”
These children prefer to play alone, do not make eye contact with others, and seem to
live in a world of their own.
PROBLEMS WITH VERBAL AND NON-VERBAL COMMUNICATION
Communication skills in children with autism develop much differently than in other
children. And, as previously mentioned, symptom severity differs from child to child.
Some children will remain mute, whereas others will speak in a sort of sing-song voice.
If you grew up in a household with other children (or perhaps are raising your own
family), does this sound familiar?...”MOM! Tell (insert name of sibling here)
__________ to stop copying what I say!!” Echolalia is the term used to describe this
“copying” or “echoing” of word(s), and is another feature observed in those individuals
affected by autism. Speech tends to develop later in children with autism, and many
times the child will refer to themselves by name (rather than “I” or “me”). The topics of
conversation are usually limited to very narrow areas or interests; and there is little
regard to another’s participation in the conversation.
These children also avoid eye contact with others. They are unable to interpret non-
verbal and social cues, such as reading facial expressions and body language, while also
having difficulties interpreting what others think or feel. To many, these children
appear to lack empathy.
UNUSUAL, REPETITVE OR SEVERELY LIMITED ACTIVITIES AND INTERESTS
Autistic children are extremely resistant to change. They prefer to maintain set
environments and schedules. Many times, they engage in ritualistic and/or repetitive
behaviors, such as rocking, spinning/twirling, and arm flapping. Disruption of these
routines or rituals can lead to tantrums, and/or inconsolable crying spells.
Many autistic children also demonstrate decreased sensitivity to pain. They may
engage in self-injurious activities, such as biting and head-banging, especially when
they are frustrated or exposed to a stressor. Despite this apparent heightened pain
threshold, children with autism can be very sensitive to sensory stimulation, such as
sound and touch. Loud noises, bright lights, and even hugging or cuddling these
children appears to be very painful for them, and may provoke crisis. These children
may also exhibit unpredictable behaviors such as tantrums and hyperactivity.
Remember some of these children lack the verbal skills to communicate their distress.
They then “act out” as a means of communication.
An area of major concern is that autistic children tend to have poor judgment skills,
such as running into a busy street without fear. Consequently, they are perpetually at
risk for danger; and require close supervision.
Sometimes these children will run away from people or things which they
perceive as stressful. These “runners” also tend to be very attracted to water.
First responders should always check nearby swimming pools or bodies of
water in the event you are dispatched to a scene involving such an individual
who is missing.
WHAT CAUSES AUTISM?
There are no certain causes for autism. In the “olden days,” maternal behaviors were
blamed for the social withdrawal associated with autistic children. These moms were
labeled as “refrigerator mothers” and it was supposedly due to their cold and unfeeling
relationship with their children that caused these kids to become socially withdrawn.
This has since been disproved, yet it wasn’t until the 1970’s that other possibilities
causing the disorder were investigated.
Since then, many theories have been proposed, and research has investigated possible
underlying neurologic, genetic, physiologic and environmental causes of autism. It is a
complex and puzzling disorder, with its spectrum of symptoms, and varying time of
onset amongst individuals. Several studies point to the role of genetics in causing
autism. Researchers have identified a number of genes associated with the disorder,
but have not isolated which gene(s) are directly responsible for causing the symptoms.
Epidemiology, the study of factors affecting health and illness of populations
(Wikipedia.com), is what flags many areas in need of research. Consequently, the fuel
for a huge chunk of research stems from the incidence of autistic symptoms developing
12-15 months after birth. Prior to 1990, approximately 2/3 of autistic children were
autistic from birth. After the 1980’s, the trend actually reversed; and 2/3 of autistic
children became autistic in their second year of life. (Adams, et. al, 2008)
Due to this shift in the onset of autistic symptoms, many scientists believe that while
genetics appear to play a large role, it is the exposure to certain environmental toxins
(such as mercury and pesticides) that causes the onset of symptoms.
YouTube contains several clips filmed by the parents of autistic children. Many of them
show images of the “normal, joyous, and interactive” child; and in the next frame, show
the progression of the autistic symptoms.
OTHER INTERESTING RESEARCH FINDINGS:
Blood from umbilical cords has been examined. Results revealed that certain
pollutants and chemicals are able to pass through the placental barrier.
Studies have found irregularities in several regions of the brain in people with
Studies suggest that people with autism have abnormal levels of serotonin or
other neurotransmitters in the brain.
Studies of identical twins show there is a much greater probability of them being
autistic than fraternal twins.
Parents with an autistic child have an increased likelihood that their future
children will also develop autism.
HOW IS AUTISM DIAGNOSED?
Diagnosing a child with autism doesn’t come about from one single trip to the
pediatrician. Typically, parents are the first link in identifying behaviors demonstrated
by autistic children. Most parents/caregivers have a general knowledge of what
developmental tasks children should be capable of by a certain age. This knowledge
comes from previous experience with children, or by observing how other babies
behave in comparison to their own. These tasks/behaviors are also known as
developmental milestones. Failure to reach developmental milestones (such as social
smiling, cooing, and babbling) or regression from these milestones indicates the need
for further investigation.
DEVELOPMENTAL MILESTONES AND YOU
Anyone caring for pediatric patients
must know important developmental
milestones because they influence
both the assessment and treatment of
these patients. But it doesn’t stop
there. Our knowledge and
responsibilities as pre-hospital
providers/health care workers
extend into our personal lives as well.
How many times have you been
asked by various friends and family
members to “take a look” at
something? How ‘bout when you’re
out to dinner? The elderly guy at the
next table is having a coughing fit,
and you’re thinking about what size ET tube you could stick down his throat. Or when
you’re sitting in a movie theatre, you’re scanning the room for the emergency exits. We
are always assessing and planning our interventions. Most of us don’t even realize
we’re doing it because it’s become automatic!
Every piece of knowledge we learn has to do with PEOPLE. People who become our
patients by calling us to help them. People who become our patients by default: i.e.
the coughing guy in the restaurant, and by sheer closeness, our neighbors, parents,
nieces, nephews and even our own children. While noting abnormal or delayed
development may not bring about the adrenaline rush you may feel after a structure fire
or successful resuscitation, its importance should not be overlooked. Think about the
impact that reporting your observations could have not only on an individual, but on
an entire family!
(For more details go to www.cdc.gov/ncbddd/autism/actearly/milestones)
Just because an individual is diagnosed as autistic, does not infer that they have mental
disability. Mental retardation can be found in autistic individuals, as it can in any other.
Autism does not mean that these children are incapable of learning. They simply
process information differently. Sometimes, autistic children will be especially (and
surprisingly) brilliant at some skill or task, such as: playing a piece of music on the
piano after hearing it one time, painting/drawing, or other skills involving memory.
“Autistic savant” is another way of referring to such a child.
By the end of 3 Months, By the end of 7 Months,
Begin to develop a Enjoy social play
Respond to their own
Watch faces intently name
Follow moving objects Use their voice to
express joy and
Smile at the sound of
Respond to other
Begin to babble and
people’s expressions of
imitate some sounds
Turn their head towards
Appear joyful often
the direction of sound
Babble chains of sounds
By the end of 12 By the end of 24 Months,
Months, children: children:
Cry when mom or dad Get excited about
leave company of other
May be fearful in some
situations Imitate behavior of
danger” Use simple phrases and
2-4 word sentences
Respond to simple
verbal requests Follow simple
Babble with inflection
(changing tones) Repeat words overheard
Try to imitate words
Screening tools have been developed to assist in the initial phases of diagnosing autism.
While some details contained in these screening tools may slightly differ, included are:
a series of questions to ask the parents/caregivers, and/or areas for direct observation
of the individual regarding social interaction of the child and their communication
skills. Based on this information, referrals to a multi-disciplinary team (including, but
not limited to: psychologists, neurologists, other specialists) is instituted.
Autism’s symptoms can overlap with those of other diseases/disorders. Consequently,
diagnosing an individual with autism requires ruling out other possible causes, such as
brain tumors, metabolic disorders, hearing deficits and seizures.
TREATMENTS FOR AUTISM
There are no known cures for autism. Treatment for this disorder is based on the type
and severity of symptoms the child shows. The most effective treatment plans are
pointed at treating the three primary symptoms of autism.
EDUCATIONAL AND BEHAVIORAL TREATMENTS
Educational and Behavioral Treatments are key ingredients in maximizing these
children’s potential. Sessions are very structured and aimed at helping the child to
develop skills in socialization and language. More and more, specialized schools and
treatment programs for autistic individuals have come into existence in our
Education for first responders/prehospital personnel has become an important focus
for autism advocacy groups. Included in the live C.E. sessions is a pamphlet designed
for paramedics and ER staff by the Autism Society of America . It briefly defines
autism, and some common characteristics/behaviors of the autistic individual. Most
importantly, the pamphlet lists some effective measures to implement when responding
to an individual with autism. (For those on-line C.E.-ers, log onto http://www.autism-
2 and you will be able to print a copy of the PDF file for this pamphlet)
Families of autistic children, much like those of chronically ill or other special needs
children are a wonderful resource to utilize during your assessment/treatments. They
tend to be very detail oriented, and are extremely knowledgeable about their child’s
symptoms, and behavior. Remember that many autistic individuals are highly resistant
to change, touch and loud noises…all things that are common elements of emergency
care. Obviously if there’s a life or death situation, all bets are off; but if time permits,
follow the suggestions offered by the caregiver. They know the most effective ways to
calm their child, and allow you to do your job.
In addition to the previously mentioned symptoms, children with autism often suffer
other maladies. These include: ADHD, Obsessive-compulsive disorders, food allergies,
pica, seizures and depression. Treatment varies, according to practitioner and the
severity of symptoms.
When a person eats non-food items, it is called pica. Chalk,
dirt, sand and paint are some examples. 30% of autistic
children have moderate to severe pica.
Autistic individuals may be prescribed medications by their physician to alleviate some
of their symptoms.
Anti-depressants help with depressive symptoms, and sometimes with
o Prozac, Zoloft
Anti-psychotics may also be used to help with anxiety, impulsiveness or
o Risperidone(Risperdal), Zyprexa
Stimulant drugs for treating hyperactivity disorders
o Ritalin, Adderall, Concerta
Anti-convulsants for treating seizures
o Dilantin, Tegretol, Depakene
SEIZURES AND AUTISM
For reasons not yet fully understood, seizure disorders are present in 20-35% of autistic
individuals. The incidence of the seizures increase as the child gets older, so one
thought is that hormones contribute to the onset of the seizures. (Epilepsy Ontario.org)
As with other symptoms observed in children with autism, the severity of seizures
differs as well. Some individuals do suffer grand mal seizures; those types of seizures
we frequently encounter in EMS. They are preceded by an aura, and usually have that
post-ictal phase; where the child is unresponsive to others, or does not immediately
resume their normal activity. On the opposite end of the spectrum are those children
who suffer milder forms of seizures; and they demonstrate a variety of different actions
or behaviors. Some symptoms seen in these milder seizures include staring off into
space, a sort of absence seizure. Still others demonstrate what are classified as
subclinical seizures, and are associated with symptoms such as: tantrums, aggression,
and/or losing some behavioral and/or cognitive gains.
Stop. Rewind. That’s no typo. Subclinical seizures can present as just like some of the
behaviors which are commonly observed in the autistic individual. A thorough history
is needed to distinguish these behaviors from subclinical seizures. Seizures do not
necessarily require a trigger event; they can just suddenly occur. If these behaviors are
thought to result from fear or frustration, they are not seizures. Again, the child’s
caregiver will be of great value in deciphering such information.
OTHER PROMISING TREATMENTS
A group of physicians, many of whom are parents to autistic children are investigating
methods (biomedical treatments) for treating autism, such as special diets and
supplements. This program is called the Defeat Autism Now! (DAN!®) program.
One of the methodologies utilized include chelation therapy, which removes heavy
metals from the body. Many physicians in the (DAN!®) program strongly suggest that
the bodies of autistic children are not able to rid themselves of metals, and this is what
predisposes them to developing autism.
Other promising treatments include supplements such as Vitamin B₁, Vitamin B₁₁,
Cod Liver Oil, Melatonin, and Zinc. Additionally, special diets which address food
allergies, and specific carbohydrate diets, and gluten-free/casein-free diets have shown
to improve autistic symptoms.
A listing of doctors who utilize the DAN!® approach can be found on the website for
the Autism Research Institute (www.autism.com). There you will also find the
Summary for Biomedical Treatments for Autism, written by James B. Adams, Ph.D.
Prognosis for autistic individuals, while dependent on language ability and intelligence,
is largely influenced by early diagnosis and treatments. This includes family
involvement in the treatment process. Each member of the family needs to be educated
and involved in order to ensure continuity of the treatment plan. Many autistic
individuals can be taught job skills, and how to live in community-based housing (with
adult supervision). There are many great resources to help educate, motivate, and
encourage those dealing with the challenges of autism.
Autism Society of America( www.autism-society.org) provides education, current
events and links to finding a local chapter in your area.
The Autism Research Institute (ARI) (www.autism.com), is a non-profit organization,
was established in 1967. For more than 40 years, ARI has devoted its work to
conducting research, and to disseminating the results of research, on the trigger of
autism and on methods of diagnosing and treating autism. They provide research-
based information to parents and professionals around the world.
ARI's Autism Resource Call Center: 1-866-366-3361
National Autism Association (ANA) (www.nationalautismassociation.org) The
mission of the ANA is to educate and empower families affected by autism and other
neurological disorders, while advocating on behalf of those who cannot fight for their
own rights. There are several links to local events and groups, as well as to current
research and treatment modalities
One Place for Special Needs (www.oneplaceforspecialneeds.com) links for all special
needs families to services, support groups, organizations and events in your local area.
Another issue of growing concern is that of childhood obesity, especially in
the United States. In this country, “We want everything hot, fresh, and
now!” (Dr. Mark Cichon, 2008)
The National Health and Nutrition Examination Survey (NHANES)
determined the obesity rates among children. The increase in obesity
rates are made by comparing the results of the surveys conducted
during 1976-1980, and 2003-2006. In children and adolescents:
ages 2-5, obesity rates increased from 5% to 12.4%
ages 6-11, obesity rates increased from 6.5% to 17%
ages 12-19, obesity rates increased from 5% to 17.6%
Obesity-related hospital costs for our youth has increased from $35
million (1979-1981) to $127 million (1997-1999).
Approximately 60% of obese children ages 5-10 years old have at
least one cardiovascular disease risk factor (i.e. elevated total
cholesterol, insulin, blood pressure, etc.; and 25% had two or more
Obesity is defined in the American Heritage Dictionary as “…increased body
weight caused by excessive accumulation of fat.” Conduct any sort of
A Recipe for Disaster
1. Take our expectation of immediate gratification and add
to it the increasing costs of food, gas and energy.
2. Mix in parent/caregiver’s working 60-80 hours per week;
or as of late, the many people who have lost their jobs.
3. Sprinkle in a little ignorance regarding healthy living.
4. Remove any remaining physical education from the school
5. Top with your choice of: TV, internet, and/or video
Serves: the entire American public.
engine search on obesity or weight-related topic, and most likely you will be
directed to a location where you can calculate your BMI.
What is BMI?
BMI, or body mass index, is a calculation of body fatness using a person’s
height and weight. The CDC (Centers for Disease Control and Prevention)
has published recommendations for acceptable BMI in both adult and
pediatric populations. While BMI does not directly measure body fat, its
results have proven to correlate with results of other body fat measures,
such as underwater weighing.
Mei Z, Grummer-Strawn LM, Pietrobelli A, Goulding A, Goran MI, Dietz WH. Validity of body mass index compared
with other body-composition screening indexes for the assessment of body fatness in children and adolescents.
American Journal of Clinical Nutrition 2002;7597–985.
What’s a “good” BMI?
The general scale for interpretation is as follows:
Healthy Weight is having a BMI between 18.5 and 24.9
Overweight is having a BMI between 25 and 29.9
Obese is having a BMI over 30
BMI is calculated differently in pediatric populations than it is in adult
populations. This is due to the fact that normal fat deposits differ between
age groups and also between boys and girls.
Screening our Children
In the 2003 mission statement of the American Academy of Pediatrics,
Prevention of Pediatric Overweight and Obesity, pediatricians were called
upon to calculate their patients’ body mass index (BMI) as a tool to aid in
the early recognition of obesity. You might be saying to yourself, how can
someone, namely a parent or a doctor, not be able to just look at a child and
tell if they are obese?!? Before casting any hasty judgment, doctors and
researchers investigated that very question. Studies have been conducted
to survey people’s views on what they consider to be obese and/or
overweight. Know what they found? There were major discrepancies
amongst various ethnic groups in regards to what is “normal”
bodyweight…hence the reason why BMI screening was implemented!
The BMI results only comprise a portion of what is involved in the screening
process. A thorough patient and parent/caregiver history of both the child’s
activity level and diet are important components as well. These pieces
provide a foundation for recognizing obesity, and also key in on those
children who, because of poor habits, are at risk for becoming obese adults.
In order to realize the urgency in addressing childhood obesity, it is important to
understand the general consequences of obesity. These consequences are both
physical and psychological.
That being said, the concern regarding overweight/obese individuals is one of
health, not physical appearance.
High blood pressure (twice as common in obese individuals)
Elevated triglycerides, with low levels of the “good cholesterol” (HDL)
Increased risk of heart disease…arrhythmias, sudden cardiac death,
Higher incidence of asthma
Increased risk of maternal high blood pressure (reference Region 8
C.E. “OB Emergencies”, April 2008)
Increased risk of birth defects (i.e. spina bifida)
Increased risk of gestational diabetes
Increased risk of complications during labor and delivery
Over 80% of people with diabetes are overweight or obese.
A weight gain of 11 to 18 pounds increases a person’s risk of
developing Type 2 diabetes twice over those who haven’t gained that
Diabetes in Children
Recall what you have learned about diabetes (Reference Region 8 C.E.,
February 2009 on diabetes. Building blocks of knowledge we are here! )
In the past, most children have been diagnosed with Type I diabetes
(juvenile diabetes). Remember with Type I diabetes, the pancreas (for a
number of reasons) doesn’t produce the insulin needed. Regular insulin
supplementation (via injections, insulin pumps, etc.) is required.
Type II diabetes had previously been considered mostly an “adult disease.”
It has been associated with many causes and risk factors. Insulin resistance
and obesity are highlighted specifically as to their roles in the development
of Type II diabetes.
Insulin resistance comes about when people’s muscles, liver and fat cells do
not respond properly to insulin. The body doesn’t know exactly what to do,
so it signals the pancreas to produce more insulin. As the lonely little
pancreas just churns out insulin to keep up with this workload, two things
happen. First, the body is unable to use this insulin to shuttle glucose into
the cells. That’s where “insulin resistance” gets its name. Secondly, when
the need for more insulin arises, the pancreas is unable to produce more.
When a person carries more weight in their abdominal area, this is called
central obesity. The fat tends to accumulate around vital organs (visceral
fat), and is known to predispose people to developing insulin resistance.
Central obesity and lack of physical activity are two major (and preventable)
causes of insulin resistance. Over the past decade, Type II diabetes has
been diagnosed in the pediatric population at an alarming rate. What’s the
link? Increased obesity rates contribute to increased incidence of diabetes.
If you could, would you relive your adolescence? That “awkward” phase that
seemed to take forever to get through? (Admit it, you have at least one
school picture you refuse to show ANYONE.) Remember what it was like?
The insecurities? Getting picked on because you weren’t good at sports, or
because you didn’t have the latest fashion accessories, or because you made
the honor roll, or because your next door neighbor was the social outcast of
the school…kids can be so cruel, can’t they? For most, body image plays a
major role in our mental well-being. It’s a part of growing up. What’s even
tougher, is growing up in American society, where we have created a
ridiculous standard for men and women to live up to, especially when it
comes to physical appearance.
For the average individual, pre-occupation with this standard is enough to
make you want to pull your hair out. For anyone who has ever been
overweight or obese, or knows a loved one who suffers because of obesity,
the consequences run much deeper. Many individuals who struggle with
weight concerns also suffer from depression, low self-esteem and anxiety.
Think about how that might affect an adult, and superimpose it into the
mindset of an adolescent.
Of course no two children react the same way, but how do these children
respond to their insecurities and self-consciousness when it comes to
weight? Well, some eat more; food is a source of comfort for them. Others
may develop eating disorders such as anorexia and/or bulimia. In fact,
some adolescents who have been diagnosed with Type I diabetes have taken
this a step further. Prior to diagnosis, many diabetics lose weight. This is
because the body needs insulin to shuttle glucose into the cells. As
mentioned, Type I diabetics lack this insulin, and require regular doses of
insulin to properly utilize that glucose. There have been several cases of
Type I diabetic adolescents who don’t take their insulin on purpose, in order
to lose weight. Kudos to their creativity, but this is dangerous! Even
potentially life-threatening behavior!
Diabetes and Depression
9% of adolescents w ith diabetes have moderately or severely
depressed mood symptoms.
Females are affected more so than males.
Depressed mood is associated with poor blood sugar control,
and leads to an increased likelihood of ER visits
(Pediatrics, 2006, 117: 1348-58)
Are these issues starting to unfold in your brain? One thing leads to
another…short-term problems cause long-term maladies. When it comes to
health, those long-term maladies are chronic, and sometimes irreversible.
Again, diabetes lends itself to a wealth of complications, and increases the
risk for so many other disease processes. Not only does the quality of life
potentially suffer as these children grow older, but think about the amount
of economic strain caused on an individual, a family and society from all of
the medical costs associated with this disease process!
Armed with the knowledge that obesity-related diabetes may be
preventable, don’t you think it would be prudent to focus some effort on
Obese individuals are at increased risk for developing some types of cancer,
arthritis, and gall bladder disease.
To sum it all up, individuals who are obese (BMI >30) have a 50 to
100% increased risk of premature death from all causes,
compared to those of a healthy weight.
Food for Thought…
What is the #1 cause of death in the United States?
Coronary Artery Disease (CAD)
What are some of the risk factors for developing CAD?
High blood pressure (hypertension)
High cholesterol (hyperlipidemia)
What did we just learn about obesity and cardiovascular risk?
Obesity contributes to the development of these risk
All of these problems have previously been associated with ADULTS. We
hold them responsible for the choices they have made and continue to
make, and the consequences they suffer. But now, our babies, our two year
olds, who are fully dependent on us, have a 12.4% obesity rate? What is
Most of us have common knowledge as to how our body ends up storing
more fat. The number of calories consumed is greater than the number of
calories needed to fuel the body’s activities. Fine. But kids usually run
around, they ride their bikes, and play all day, right? Come on, is this really
what today’s children are doing? Do they have physical education at school?
(Some states do not require P.E. in school) Do they play tag? What are
they doing after school? Maybe some sports, but the amount of time spent
texting, or in front of the TV, computer and video games has increased
exponentially! “Mom don’t shut it off! I just got to level 7!” Our children are not
addicted to these modern electronics because of their novelty, but rather,
because they have become a part of our culture. Therein lies the first of
many causes contributing to our obesity rates: Lack of physical activity.
Long gone are the days when families ate all three home-cooked meals (with
a healthy after-school snack) at the table, served by a smiling mom in an
apron. How have American family dynamics changed over the past 4
decades? Working moms. Single parent homes. Both parents working.
Who makes dinner now? Many children are responsible for feeding
themselves these days. What’s for dinner? Fast food, microwaved
something…all washed down with some sugar-laden drink (pop, fruit-juice
drink, etc.). Fresh fruits and vegetables? Nope. Milk? Not so much.
“All my kid will eat is macaroni-and-cheese and french fries!” (Some parents actually
laugh when they say that) We are teaching our children that it is ok to insert
fast food to accommodate our fast lifestyle. And now, like the electronics,
fast food/junk food is an addiction because it is a part of our culture. In
addition to the amount of calories that we feed our children/our children eat,
we must also look at the nutritional sources of those calories as well.
Let’s throw back to Old School…
Remember the food pyramid?
How many of us as adults
actually follow those guidelines?
We are the first models for our
children’s behaviors. If we don’t
follow healthy guidelines, why
would our children?
How about Popeye? “…Strong to the
finish, ‘cuz I eats me spinach!”
SPINACH! Not stuffed pizza with
“An apple a day keeps the doctor away.” Amazing…with all of the advances in
technology, medicine and overall know-how, why is it that the older
generations understood health and nutrition better than we do?
Another problem of nutrition is that healthy food can be more expensive
than not-so-healthy-foods. This leads us to a rather interesting discussion
regarding the patterns of obesity amongst various socioeconomic groups.
Obesity can be found amongst all socioeconomic groups. However, the
reasons for why they exist are different.
In wealthier socioeconomic classes, some factors which contribute to the
overweight/obesity incidence are:
Divorce guilt—Parents give their children whatever they want to earn
their love/trust or to “make up” for the divorce.
Children have easier access to technology-computers, video games,
cell phones… this lends itself to a more sedentary lifestyle.
There’s more food in the home to eat.
These children may have easier access to buying whatever food they
want, especially if they are given an allowance to spend.
In lower socioeconomic classes other factors contribute to the incidence of
Many healthy foods are more expensive than fast food/junk food.
Many children have working parent(s), and are responsible for feeding
themselves. The solution? Fast food/junk food/microwaveable food.
Healthy food costs more. Neither these
families nor the school systems may be
The President’s Challenge
able to afford healthy, fresh food. is a program which
Ignorance as to healthy choices. promotes an active
Fewer playgrounds in the neighborhoods
where they live lifestyle.
Less access to extra-curricular (www.fitness.gov) Here,
activities/sports kids may earn medals for
their fitness efforts. It’s a
The rise in childhood obesity is not unique to fun way to get children
the United States. The overall obesity rate is
increasing across the world. Global studies of
and their families
countries/areas of the Western Hemisphere involved.
have shown that the relationship between
socioeconomics and obesity depends on the
stage of economic transition. Early in the transition, the more wealthy an
area is, the greater the obesity rate. Later in the transition, the less wealthy
an area is, the greater the obesity rate.
WHAT DO WE DO NOW?
As with anything, identifying that there is a problem is the first step. As
with every facet of life, we need to be accountable for ourselves first. WE
are responsible for our children. Not the school systems, not the
government, but us as parents and adults. Children model behaviors that
they see. Treating obesity and implementing a healthy lifestyle for our
children will only be successful if we are motivated to actually practice what
WHERE DO WE BEGIN?
Several governmental bodies have been developed to educate the public and
have taken initiatives encouraging healthy lifestyles. The Surgeon General’s
Call to Action to Prevent and Decrease Overweight and Obesity, and The
President’s Council on Physical Fitness and Sports are two examples.
One of the most important things we can do for our children is to get them
physically active. The U.S. Department of Health and Human Services
released the 2008 Physical Activity Guidelines for Americans
(www.health.gov/paguidelines) which discuss all aspects of the “how’s” and
“why’s” as they pertain to physical activity for Americans ages 6 and older.
There’s TONS of information here! These recommendations are for health-
related fitness; NOT performance-related fitness. Chapter 3, Active Children
and Adolescents, provides the guidelines for physical activity in our youth.
Key Guidelines for Children and Adolescents
Children and adolescents should do 60 minutes (1 hour) or more of physical
o Aerobic: Most of the 60 or more minutes a day should be either moderate- or
vigorous-intensity aerobic physical activity, and should include vigorous-intensity
physical activity at least 3 days a week.
o Muscle-strengthening: As part of their 60 or more minutes of daily physical
activity, children and adolescents should include muscle-strengthening physical
activity on at least 3 days of the week.
o Bone-strengthening: As part of their 60 or more minutes of daily physical activity,
children and adolescents should include bone-strengthening physical activity on at
least 3 days of the week.
It is important to encourage young people to participate in physical activities
that are appropriate for their age, that are enjoyable, and that offer
YOU ARE WHAT YOU EAT
Another area to improve is nutrition. Again, we must set the example.
Providing healthy foods for our children to eat. Here’s a tip when grocery
shopping: avoid the middle aisles! The healthy foods are usually around the
perimeter of the store (barring the bakery section).
What are the two most common reasons people give as to why they cannot
do something? Lack of time, and lack of money.
“But I don’t have time to cook…” Don’t sell yourself
Currently, the Acting Surgeon
short! Americans are creative and full of
General, Steven K. Galson is on a
nation-wide tour promoting the
Healthy Youth for a Healthy Future Get a slow-cooker.
project. This is to recognize several
communities throughout our country Pack lunches before going to sleep at night.
who have taken measures to promote
healthy lifestyles, and decrease Prepare meals ahead of time and freeze them.
Engage your family to help come up with some
Even though they may complain, roll their eyes, and make all sorts of
huffing sounds of disgust, engaging our children in these activities will help
their self-esteem! How? They are directly involved in tasks which keep the
family healthy. There is one caveat: we must explain WHY their
participation is important, AND express our appreciation for that
participation. It’s not what you say, it’s how you say it!
“It’s too expensive…”
Another great resource is from The National Heart Lung and Blood Institute,
entitled: WeCan! Ways to Enhance Children’s Activity & Nutrition
(www.wecan.nhlbi.gov). There are all sorts of money-saving tips while
Don’t forget to utilize the resources your pediatrician may have access to,
such as a nutritionist. Weight loss, especially in the pediatric population
needs to be monitored by a physician. Children are not tiny adults;
remember their bodies are still growing. They have unique nutritional
requirements that must be adhered to, to promote things such as healthy
bones, to last long into adulthood.
We can come up with excuses from now until eternity. This is about our
children and teaching them good habits. This is about arresting the increase
in childhood obesity, and preventing further complications of this disorder.
If your “why” is great enough, you’ll find a way.
Drug of the month - Versed
Short-acting benzodiazepine with CNS depressant, muscle relaxant, amnestic and
Dosage depends on age group and indication
o Pediatrics: (IV/IO route) 0.05mg/kg up to 0.2mg/kg maximum
o Drug Assisted Intubation
o Side Effects:
o Respiratory depression
o Contraindications: Hypersensitivity, pregnancy, narrow-angle glaucoma. Caution in
COPD, renal failure, CHF, elderly, concomitant alcohol or CNS depressant medication
Rhythm of the Month
Sinus Bradycardia and Pediatric Bradydysrhythmias
Hypoxia, hypothermia, increased vagal tone, increased intracranial pressure, drug
HR < 60
P-wave : QRS = 1:1
PRI = < 0.20 sec, does not change
QRS < 0.12 sec
Illinois Region 8 Emergency Medical Services
Central DuPage, Edward, Good Samaritan, Loyola EMS Systems
Standard Operating Procedures
Illinois Region 8 EMS Systems - Revised 2006
1. Assess for causative factors, such as hypoxemia, acidosis and hypothermia.
Initiate corrective resuscitative measures as necessary
2. Initial Medical Care
Adequate airway and ventilation is essential
Initiate CPR if, after adequate ventilation, the heart rate remains < 60 per minute
If signs of hypovolemia: NORM AL SALINE 20 ml/kg IV push
3. EPINEPHRINE 1:1000 0.1 mg/kg (0.1 ml/kg) ET or
EPINEPHRINE 1:10,000 0.01 mg/kg (0.1 ml/kg) IV/IO. Repeat q 3 minutes as
long as dysrhythmia with hypoperfusion persists.
4. ATROPINE 0.02 mg/kg rapid IV/IO or 0.03 mg/kg ET. Minimum dose 0.1 mg.
Repeat q 3 minutes until maximum total dose admin.
Maximum single IV/IO dose is 0.5 mg ≤8 years, 1 mg > 8 years.
Maximum total IV/IO dose is 1 mg ≤8 years, 3 mg > 8 years.
5. External Transcutaneous Pacing: Contact Medical Control.
Flush all IV/IO drugs with 5 ml NS
Flush or dilute all ET drugs with 5 ml NS
Attempt to keep child warm with protected hot packs and blankets as a
(n.d.). Retrieved December 02, 2008, from Health Scout:
(n.d.). Retrieved December 02, 2008, from The President's Challenge:
Adams, J. B., Edelson, S. M., Grandin, T., & Rimland, B. (2008, Revised). Advice for
Parents of Young Autistic Children. Autism Research Institute, San Diego.
American Heritage Dictionary of the English Language, 4th edition. (2006). Houghton Mifflin
Autism Society of America. (n.d.). Autism Information for Paramedics and Emergency Room
Staff. Retrieved December 10, 2008, from http://www.asa.gov
Epilepsy Ontario. (n.d.). Epilepsy/Seizures and Autism. Retrieved December 02, 2008,
Ford, E. S., & and Mokdad, A. H. (2008). Epidemiology of Obesity in the Western
Hemisphere. The Journal of Clinical Endocrinology and Metabolism , 93, 51-58.
Jensen, C. D., & Steele, R. G. (2008). Body Dissatisfaction, Weight Criticism and Self-
Reported Physical Activity in Preadolescent Children. Journal of Pediatric Psychology , v1,
Lawrence, J., Liese, A., Liu, L., Dabeela, D., Anderson, A., & Imperatore, G. B.
(Published on line September 22, 2008). Weight-Loss Practices and Weight-Related
Issues among Youth with Type I or Type II Diabetes. Diabetes Care , 31, 2251-2257.
Levine, S., & and Stein, R. (2008, May 17). Obesity Threatens a Generation. Retrieved
December 01, 2008, from Washingtonpost.com: http://www.washingtonpost.com/wp-
National Health and Nutrition Examination Survey (NHANES). (2006). NHANES Health
and Statistics Prevalence of Overweight Among Children and Adolescents: United States. CDC
National Center for Health Statistics. www.cdc.gov.
National Institute of Neurological Disorders and Stroke. (n.d.). Retrieved December 02,
2008, from http://www.ninds.nih/gov/disorders/autism/detail_autism.htm?
U.S. Department of Health & Human Services. (n.d.). Retrieved December 01, 2008,
U.S. Department of Health and Human Services. (n.d.). Retrieved December 01, 2008,