harmful effects of second-hand smoke on children

If children live in a home where people do not smoke while the children are present, but do smoke a lot when they are not, how dangerous is the smoke that is in the carpet and furniture to their lungs?

Tobacco smoke that is released into the air by a cigarette, cigar, or pipe is known as second-hand smoke or Environmental Tobacco Smoke (ETS). It comes from the actual burning of the cigarette or the smoke that is exhaled (breathed out) by the smoker. This smoke contains several toxic parts that can lead to medical problems, including cancer.

Infants and children are most at risk from these toxins because their lungs are still developing and are considered more delicate. Children whose parents smoke have a higher chance of showing breathing problems. ETS has been associated with asthma, tonsillitis, bronchitis, pneumonia and other upper respiratory and lung infections. In addition, parents are very powerful role models for their kids. Children whose parents smoke are more likely to begin smoking themselves in adolescence.

How much harm does exposure to second-hand smoke cause? This depends on how much smoke is in the air and for how much time a person is exposed. The amount of ETS is affected by the size of the space, the number of people smoking in it and whether there is proper ventilation. After the smoking in an area has ended, it can take upwards of 3-4 hours to remove the smoke from just one cigarette and even then some of it may still linger.

There is a great amount of research to be done about the effects of second-hand smoke, including how harmful the leftover residue in places such as the carpet is. Currently the only known way to prevent these harmful effects of second-hand smoke is to never expose children. Not smoking at all is best for both the smokers and their children.
Henry H. Bernstein

recurrent miscarriages and having baby

I am 31 years old. In the last three years I've been pregnant three times, resulting in early miscarriages. My doctor says there is nothing wrong with me. I want to have a baby -- what can I do?
Recurrent miscarriages are really a tragedy for a couple, and I wish you good luck. And looking at statistics, I really think that you will have good luck. The chance of a miscarriage happening in any pregnancy is about 15%. The majority of miscarriages are caused by the sperm and egg failing to join together properly. If you study the genetic makeup of most fetuses that are miscarried, they are abnormal. Given all the tricky things that can happen when fertilization occurs, I am really surprised there aren't more miscarriages occurring.

The good news is that if one suffers a miscarriage, the odds are the same 15% of suffering a miscarriage in the second pregnancy. And even if a woman has gone through three miscarriages, the odds are 75% that she will carry a healthy pregnancy on the fourth attempt. (mary jane minkin, MD)

There are certain medical conditions that do increase the risk of recurrent miscarriages, and it sounds like you have had some of these investigated. Occasionally, women do not ovulate well enough -- a condition called inadequate luteal phase -- which can be monitored by doing a blood test to measure your progesterone level a few days before you are due to get a period. Some women have antibodies to a pregnancy, and these can be checked by blood tests for anticardiolipin antibody and lupus anticoagulant. Rarely, either you or your husband may have a genetic abnormality, which can be checked by looking at the chromosomes (called balanced translocation) from either parent. Finally, you could have some abnormality in your uterus, such as a polyp, fibroid or septum, which can be removed -- this would be discovered by doing an x-ray of your uterus called a hysterogram, or by looking inside your uterus with a hysteroscope.

If all these tests have been done and are normal, the odds are overwhelmingly in your favor. I would encourage you to go for it, Naureen. If these tests uncover a problem it can be dealt with, and I encourage you to, as the ads say, just do it. Good luck.

murmur of MVP in children

Question : As a child I was dx with MVP. When I last saw my cardiologist for near fainting spells, unexplained racing beats while resting, and dizziness after swimming laps, I was told that I had grown out of it. I recently had a physical for my new job with the state and the physician asked me if I knew I had a heart murmur. I told him that as a child I had been dx with MVP and had an echo at 12. My question is why did the state physician hear a murmur (graded it at +2) and my cardiologist did not? I do not know if I have regurgitation, I am now 23. Should I have a repeat echo?

The murmur of MVP can be heard sometimes and inaudible at other times. Since your cardiologist didn't hear it, I doubt if you have a significant leak. If you are healthy and can exercise as well as others your age, I would never get another echo. MVP is benign, unlikely ever to have and bad effect on your heart. On the other hand, if you are worried, why not get another echo. Echoes are absolutely harmless.

Passive Smoke Exposure Increases the Incidence of Sinusitis in Children

Persons who smoke cigarettes demonstrate dramatic increases in their levels of nicotine and nicotine metabolites; however, it is now clear that others who are exposed to the exhaled smoke (so-called "passive smokers") can also demonstrate nicotine levels that may affect their health and well-being. This health risk is particularly important in children. Research to date indicates that children exposed to passive cigarette smoke have elevated rates of otitis media, bronchiolitis, and diminished pulmonary function, as well as more frequent exacerbations of asthma.

A direct correlation has been observed between the extent of exposure to passive smoke and urine cotinine values. Cotinine is a metabolic by-product of nicotine that is readily measured in the urine. Numerous investigators have concluded that there is a correlation between the frequency of symptoms and signs of respiratory illness, such as nasal symptoms and even asthma, and levels of cotinine in the urine.

To further define what effect passive cigarette smoke may have on the health of children, Steven Stryk and colleagues from the St. Louis University Health Sciences Center asked parents to complete a detailed questionnaire about their smoking habits. They also collected urine samples from children in these households and periodically analyzed the cotinine/creatinine ratio (CCR), which serves as a highly reliable measure of exposure to nicotine. They are now following these children prospectively under double-blind conditions to determine their rates of sinusitis.

Previous studies have indicated that a CCR of 30 mg/mL or higher reflected significant exposure to nicotine through passive smoke inhalation. For example, Dr. Stryk noted that in smokers, one cigarette can increase the urine cotinine levels by about 135 ng/mL, and some smokers have urine cotinine levels of up to 1,000 ng/mL. In the twenty children (aged 3--18 years) studied to date, Stryk and his team have identified five children with urine cotinine levels higher than 30 ng/mL. One 5-year-old had a urine cotinine level of 298 ng/mL! Among these twenty children, there have been eight cases of sinusitis. Key to these findings is that all of the infections have occurred in the five highly exposed children.

In addition, the investigators found that whether or not their mother was a smoker was very highly correlated with the children's urine cotinine levels. Such findings suggest that when a mother smokes, the child may absorb clinically important levels of nicotine, and that these levels in many cases can affect the respiratory health of these children. source:AAAAI

Encasing Mattresses Improves Asthma in Children

According to some investigations, up to half of the cases of childhood asthma are exacerbated by the presence of allergens found in the excrement of the common house dust mite. Consequently, one way to combat asthma is to limit the exposure of children to these dust mite allergens. Removing carpeting and washing bedding are good ways to reduce the dust mite load in homes. New research also confirms that encasing the pillow and mattress of asthmatic children can have a dramatic benefit for their asthma status.

Dr. S Halken and colleagues evaluated the benefits of using a semipermeable mattress cover (Allergy Control brand) designed to prevent the passage of dust mite allergens. Sixty asthmatic children were given either the test covers or simple cotton covers, through which dust mite allergens could penetrate. The children were followed for 1 year. In the groups of children who used semipermeable covers, the concentrations of house dust mites decreased almost 10-fold, compared to only a 50% drop in the control group. Furthermore, the mean dose of inhaled corticosteroid decreased by about 50% in the semipermeable cover group (p = 0.003 compared to baseline) but only by about 25% in the control group . Morning and evening peak flows increased significantly in the semipermeable cover group, but only evening peak flow improved significantly in the control group.

These findings suggest that the use of a semipermeable mattress and pillow cover was associated with:

• a decrease in the concentration of house dust mites in the mattress

• a drop in the dose of inhaled steroid

• a decrease in allergen-specific bronchial hyperreactivity

• a decrease in nighttime asthma symptoms, and

• an increase in morning and evening peak flow measurements.

source:AAAAI

controlling allergy symptoms for children

Managing symptoms of allergy
Managing allergies properly should be an important part of your child's training and preparation for competition.

Classic allergy symptoms — such as a stuffy nose, watery eyes, sneezing and sinus pain — can affect your child's performance and most importantly, enjoyment of the activity. Allergy symptoms can make it difficult for your child to sleep at night.

Enlisting the help of your physician and getting an early start in controlling allergies can help prevent these problems. "As in sports, the best defense against allergies is a good offense," says Dr. Li. "Don't wait until the middle of the season to recognize there's a problem and to start treating it."

Before the season starts, ask your physician about your child's allergies and how they might affect his or her chosen activity. Tell your physician if your child is having trouble this year with any new symptoms. If your child isn't taking a medication, your physician might recommend one. If your child is taking a medication, ask your physician to evaluate both it and its dosage.

This might be especially important if your child is competing at the top levels of his or her sport. Some medications, such as oral decongestants, might be considered stimulants and athletes might be banned from using them.

As the beginning of the sports activity draws closer, Dr. Li recommends making sure that your child is taking the medication on schedule and isn't skipping doses. "Allergy medications work best when used early and regularly," he says.

You might also wish to add your child's coach to your allergy-management team. On days when allergies might be particularly troublesome for your child and others with allergies, the coach might be able to modify practice routines to prevent allergies from affecting athletes. Chances are, your child won't be the only one on the team with allergies.

Children, allergies and sports

If your child has hay fever, does that mean outdoor sports are off limits? Not at all, according to James Li, M.D., a specialist in allergy, asthma and immunology at Mayo Clinic in Rochester, Minn.

"Any athlete, from preschooler to pro, can have allergies and participate in sports," says Dr. Li. "Some professional athletes even compete when their allergies should be at their worst. With the right treatment, your child can compete in any sport he or she wants."

Considering options
Although it's true that allergies don't have to be an athletic roadblock, it's important to note that there might be better sports for your child to choose if he or she has severe allergies to outdoor pollens or molds.

If your child is just beginning to compete, consider taking a closer look at indoor sports or ones in which competitions take place during winter months. The reason? Your child likely will encounter fewer outdoor airborne allergens, such as pollen.

James Li, M.D."Good choices include swimming, basketball, ice hockey or indoor volleyball," says Dr. Li. On the other hand, indoor sports might aggravate allergies to indoor molds or dust mites.