My heart goes out to the families and friends of those who lost their lives in this horrific tragedy. There are no words that can heal your pain. There is no action that can undo what has been wrongly done to you.

But it’s time to tackle this issue boldly. The tragic deaths of these 20 innocent children and of the 6 brave adults who stood up to the gunman are the tip of an iceberg. Thousands go through this every year. More American kids are killed by gunfire every year than all US soldiers killed in Afghanistan from 9/11 through 2012.  Combined.

The war is at home.

And it’s not inevitable. Almost 12 times more US kids are killed by guns than in any of 25 other industrialized nation. And when it comes to homicide, it’s 16 times more killed by gun than in the other industrialized nations combined.

This demands the question, what’s the difference?

Consider Seattle versus Vancouver. These similar neighbor cities have very different gun death stats. What’s the difference? It’s not a difference in video games or movies. It’s not a difference in security measures or in mental illness. One glaring difference between those cities – and between us and other countries – is the ease of obtaining guns.

And in 2011 a law was passed in Florida forbidding pediatricians from even talking with their patients about gun safety and keeping guns safely away from kids. We protect our gun owners more than our kids. Kids deserve freedom too.

Pediatricians come in all political stripes, but more than 90% of pediatricians favor some form of reducing easy access to guns.

We pediatricians understand that when it comes to kids health, the elephant in the room is guns. Guns are killing our kids. Through homicide, suicide, and accident they are a leading cause of death throughout childhood. And overall, the death rates of kids from guns are the same in urban centers and in farm country. It’s an issue for all of us, not just for people leaving someplace else.

I know there are many other aspects to this story – helping families cope, school safety strategies, teaching kids non-violent problem solving, etc. – but we need to wake up to the scope of the problem. Another Newton is not inevitable.

Continuing this is our choice.

Who would want to give their children nightmares? Or night terrors? Who wants to make bedtime battles worse? Who would want to make it take longer for their children to fall asleep once they get in bed?  Who wants their kids to sleep worse when they finally do drift off? Who wants their children to be more tired and cranky during the day? Just being exposed to secondhand smoke can do all of these things, at least for some for kids, according to a study published January 18, 2010 in Pediatrics.

The researchers looked at sleep issues in kids who were already enrolled in a different study on asthma treatments. They analyzed the sleep patterns of 219 kids with asthma who were exposed to secondhand smoke versus other kids with the same severity of asthma who didn’t get the smoke exposure. The results were striking, and went beyond what they would expect just from the breathing problems we know are caused by secondhand smoke.

While this study only included children with asthma, the researchers suggest that being around smoke may affect the sleep of kids without asthma as well. I also wonder if other fumes, as from harsh household cleaners, might affect sleep as well.

Our kids deserve clean air, especially in their own homes.

• Try to keep cigarette smoke, harsh fumes, and chemical fragrances out of the home.
• Open windows when you can to let fresh air in (almost always cleaner than inside air).
• Consider a houseplant for your child’s room (can remove up to 90 percent of pollutants).

Yolton, K., Xu, Y., Khoury, J., Succop, P., Lanphear, B., Beebe, D.W., and Owens, J. “Associations Between Secondhand Smoke Exposure and Sleep Patterns in Children.” Pediatrics, online 18 Jan 2010, (doi:10.1542/peds.2009-0690).

Controversial new guidelines from the American Academy of Pediatrics call for more children to get their cholesterol checked, starting as young as age 2, and for some kids to be started on statin drugs to lower their cholesterol, starting as young as age 8. I’m glad that the controversy surrounding these guidelines is starting to draw some attention to some important facts:

1) cardiovascular disease is the biggest killer in this country;
2) the habits that contribute to it are often formed during childhood; and
3) it’s not just the habits that start in childhood. The blood vessels are already changing. Fatty streaks that will one day become MI’s and strokes are already starting to form.

I agree with the importance of starting lifestyle changes now for kids with abnormal cholesterols: otherwise it’s likely to get worse over time. For this reason, I like the idea of the screening test. Knowledge is power. I prefer parents having more information about their kids’ health, not less. The results can help to identify when a child is at risk, and also help give motivation to make real changes. Lifestyle changes can be hard. Seeing your child’s test results may help shake you (and them) out of old habits. I am afraid, though, that the test results may be misused.

I’m concerned that including drugs in the general guidelines will lead too many people to rely on the drugs rather than doing the hard work necessary to control weight, change diet, and increase physical activity. For most of us, it’s changing these habits that is key to long-term health. And establishing healthy habits in the first place is key to prevention.

With stain drugs’ presence in the guidelines, pharmaceutical companies may use the opportunity to heavily advertise and promote their use in 8 year olds. While one of these drugs may be the right choice for an individual child, depending on his genes and other risk factors, recommending them broadly is another matter, even though lifestyle changes are recommended first. We don’t know yet the long term side effects of using these drugs in pre-pubertal kids. We also don’t know whether taking them during childhood would prolong life at all; it’s not even clear that for adult men who have not had heart attacks, or for any adult women, that taking them will prolong their lives. We do know that these medications can cause side effects.

Let’s use these guidelines as a wake up call to start building healthy habits of active play and healthy amounts of healthy food for all of our kids now.

Daniels SR, Greer FR, and the Committee on Nutrition. Lipid Screening and Cardiovascular Health in Childhood. Pediatrics. July 2008; 122:198-208.

MRSA infections now kill more Americans than does HIV/AIDS, according to a CDC report in the October 17, 2007 Journal of the American Medical Association. Most of these infections are in adults over age 65, but infections with resistant bacteria are on the rise, even among healthy children. The important bacteria for parents to know about are called Staph. Aureus,  often called just “staph”.

These bacteria are very common on the skin and in the noses of healthy kids. Sometimes they slip through a break in the skin and cause infections. In fact, they are among the most common causes of skin infections – usually just little pimples or boils.  In hospitals, though, the infections were sometimes lethal, because the bacteria became resistant to major antibiotics. Now resistant staph is showing up in schools. When the bacteria become resistant to antibiotics, they can spread rapidly through communities. In some places in the US, MRSA infections (methicillin-resistant Staph. aureus) now account for 75 percent of staph infections in otherwise totally normal children. These infections are more common where kids are in close skin contact, such as in daycare centers and in contact sports (perhaps daycare is a contact sport!). On average, they are more common in kids under 2 than they are in teens.

Most of these infections can be successfully treated, especially if caught early, but occasionally they progress to serious or even fatal infections.  This week, another previously healthy high school student died from MRSA. How do you know if your child might be infected? MRSA infections usually begin as infected bumps on the skin, or what people might think are just infected “insect bites” or “spider bites”. They usually start at a place with a scrape, bite, or cut – or a place on the body covered with hair. The American Academy of Pediatrics says in their 2007 MRSA management alert that any suspected insect bite or spider bite should now be considered MRSA until proven otherwise. And how do you prove otherwise? Have a doctor drain some of the pus from the middle of the lesion and send it for culture. In a previously healthy child, if the infection is small it can usually be treated with drainage (possibly adding a MRSA- appropriate oral antibiotic – TMP/SXT, clindamycin, or doxycycline for kids over age 8 – but NOT one of the typical antibiotics used to treat skin infections). If the wounds are large, though, or the children are very sick, they may need to be hospitalized for emergency treatment.

How do you help prevent MRSA? Keep scrapes and cuts clean and covered. Keep the hands clean with soap and water or instant hand sanitizers. Take a soapy shower after sports. Minimize sharing towels, razors, or other objects that rub the skin (and clean shared toys often).  But perhaps the most important take home message is just to be on the lookout for superbugs at school. Be sure your doctor knows about any red, swollen, or painful bumps that may be filled with, or draining, pus. Early treatment usually does the trick.