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Sanjay Gupta MD

Medical Action Plans for School Children; Schools Go Without Nurses Despite Need; Study Shows Dads Over 40 Are At Higher Risk Of Fathering Children With Autism; Unnecessary Dieting May Lead to Dangerous Eating Disorders

Aired September 09, 2006 - 08:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

RICK SANCHEZ, CNN ANCHOR: Welcome back. I'm Rick Sanchez. This is what is right now in the news. NASA hopes to launch the Shuttle Atlantis less than three hours from now. If the mission doesn't lift off today, the next window of opportunity opens in October.
Suspected cop killer Ralph Buck Phillips is already in custody this morning, following a massive manhunt. He surrendered last night when police cornered him in a field in northwest Pennsylvania. Phillips is due in court in about 90 minutes.

Afghanistan's Kandahar Province is the site of a week long anti- Taliban sweep. NATO says allegiance and alliance forces and the Afghan troops killed at least 40 insurgents overnight during this fighting.

CNN's Anderson Cooper's in Afghanistan. As part of our 9/11 anniversary coverage, you can watch "A.C. 360" Monday at 10:00 p.m. Eastern.

Iran and Iraq -- talks are set for Monday between those two nations. Iraq's prime minister will travel to Tehran. Up for discussion, politics and security. Iran and Iraq fought in a bloody war in the 1980s when Saddam Hussein was in power. Relations have improved since the U.S. invasion, interestingly enough.

And a nuclear reactor shut down in Norway. It happened at a research facility where a spokesperson says "a minor incident was caused by an abnormality." The spokesperson says that nothing was released into the environment. Investigators say they are looking into it.

Your next check of the headlines is coming up at the top of the hour. But first, "HOUSE CALL" with Dr. Sanjay Gupta's coming up right now.

UNIDENTIFIED FEMALE: Coming up on HOUSE CALL, forget about finding the right backpack. What about preparing your kids for the onslaught of classroom germs?

Plus...

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: When a child has a terrible allergic reaction, or when a child has an asthma attack, who's going to take care of them? Our secretaries.

(END VIDEO CLIP)

UNIDENTIFIED FEMALE: Find out why school nurses are a vanishing breed. And discover how teen girls are setting themselves up for eating disorders.

DR. SANJAY GUPTA, CNN SR. MEDICAL CORRESPONDENT: Welcome to HOUSE CALL. I'm Dr. Sanjay Gupta.

Well, children across the country are heading back to school, but getting ready for class is more than just buying new clothes and notebooks. Today on HOUSE CALL from kindergarten to college, we found out what you need to know before your kids hit the books.

(BEGIN VIDEOTAPE)

CINDY AREGLADO, MOTHER: Are you having a lot of fun?

GUPTA (voice-over): This is a big year for Christopher Areglado. The five-year-old is just starting kindergarten.

CHRISTOPHER AREGLADO: I'm very excited to go off to kindergarten this fall because I like to play. Whoo!

GUPTA: But for all the excitement, there's also some anxiety for Christopher's mother.

C. AREGLADO: It's definitely worrisome for me due to the fact he has asthma and he has food intolerances. And for the first time, I'm depending solely on other people to help him.

GUPTA: Asthma is one of the most common childhood diseases.

C. AREGLADO: Take a deep breath.

GUPTA: And one study found that more children are hospitalized for asthma in September than any other month.

UNIDENTIFIED FEMALE: There's a lot of asthma that is triggered by viruses. And in September, when the children return to school, there's viruses are spread a lot more commonly because they're in such close proximity to each other.

UNIDENTIFIED MALE: Ah.

UNIDENTIFIED FEMALE: Ah.

GUPTA: That proximity exposes kids to a slew of germs that can lead to all kinds of illnesses.

UNIDENTIFIED MALE: Coughs, colds, diarrheal illnesses, eye infections, and sore throats or strep throats, those are the things that you'll see most commonly in children when they're back in school.

GUPTA: Doctors see an increase in young patients about a month into the school year. Between the germs in school and being on his own, Christopher's mom is worried.

C. AREGLADO: It's nerve-racking. You know his -- you're not sure does he have a cold? Or you know, is he reacting to something else? Because I'm never quite sure what's causing it or how long he'll be sick for.

GUPTA: Experts say if your child has a chronic condition like asthma, an action plan is critical.

C. AREGLADO: We met with the school nurse. I feel much better about everything. We went over the plan. We tweaked the plan so everyone's pretty much on board.

GUPTA: Christopher's pediatrician also developed a plan for his food intolerances. Something this little boy knows all too well.

CHRISTOPHER AREGLADO: I can't have milk, eggs and cheese. Because they -- because it will make my belly sick.

GUPTA: Food allergies more severe than food intolerance, which is what Christopher suffers from. Allergies to foods such as peanuts can be life threatening.

UNIDENTIFIED FEMALE: Children with food allergies need to know not to trade food at school. They need to recognize the signs and symptoms of their food allergies. They need to immediately contact an adult if they feel as though they are having a reaction.

C. AREGLADO: Sometimes Thomas pulled freight cars.

GUPTA: As for Christopher, while he's dreaming about all the fun at school, his mother is breathing easier, knowing she's done her homework and has a health plan in place for her son.

C. AREGLADO: He's so excited. And I'm really excited for him. I think it's great.

(END VIDEOTAPE)

GUPTA: All right, good luck, Christopher. And medical action plans can be designed for any childhood condition, from asthma to diabetes. The idea, everyone will know what is to do if an emergency happens.

And talking to us about what to expect this year at school is Dr. Ari Brown. She's a spokesman for the American Academy of Pediatrics. She's also the author of two books on parenting. The most recent is "Toddler 411."

Good morning, doctor.

DR. ARI BROWN, PEDIATRICIAN: Hi. Thanks for having me. I'm doing great.

GUPTA: And full disclosure, my wife and I have one of your books at our house. We have a toddler and we have your book. BROWN: I'm hoping it's helping you, Sanjay.

GUPTA: Well, it is very much. Thank you for that.

Let's get right to it. You know, what -- you do this. What are the biggest concerns for children of all ages as they return to school?

BROWN: Well, you know, two of the things that you've talked about this in piece already are asthma and food allergies. We've got 5 million kids in the United States who have asthma. And about 6 percent of kids have food allergies. And so, this is a problem.

There's going to be several children. And in each elementary, middle school, and high school with these problems. And so it's important to have an action plan for an emergency should it arise. And it's also important to do some preventive work so that your child can participate in activities and not feel excluded.

A child who has asthma may be set off by exercise. So there's things you can do to prevent some flare-ups with exercise. A child who has food allergies may not be participating in a child's birthday, you know, celebration. A mom might bring in a cupcake or cake for those kids. And that child is going to be excluded because they may not know what's in that food.

And so, there are things you can do to help children feel like they're participating in all of these activities at school.

GUPTA: I think that's very good advice. They're not only focusing on their medical conditions, if they have one, but what that -- what sort of impact that might have on them in school.

BROWN: That's right.

GUPTA: Let's dig down. We'll get to some e-mail questions now starting with one from Susmita in California.

"I have a girl who's going to 8th grade and a boy who is going to 2nd grade. What are the main health issues we should take care of, other than the regular shots, before they start going to school?"

You talked about this a little bit, already, Dr. Brown, but what are the things for an eighth grader and a second grader?

BROWN: Well, eighth graders, we're going to talk about health issues. And that's going to be staying physically active, and also, eating a healthy diet because let's face it. Hamburgers and French fries are norm for middle schoolers. So those are things you need to set up with your child before they head off to school.

But then there are also a lot of social pressures for those middle schoolers. And it's a good idea to know who your kids' friends are because risky behaviors start in that age group.

For the second grader, again, healthy lifestyle issues, exercise, and eating the right foods. But then also, academically, you want to make sure that your child is remembering things that they learned in first grade and may have forgotten over the summer. I have a second grader at home. So we went over all of our math facts before school started.

GUPTA: Well, you're a good mom, for sure. That's something to think about for all parents, I'm sure.

BROWN: Right.

GUPTA: Another e-mail now coming in from Catarina in Texas who writes this. "We have a preschooler going to 'school' two days a week for the first time. What can we do to boost her immune system?"

And Dr. Brown, you just mentioned that you have two children I believe in elementary school.

BROWN: Right.

GUPTA: And boosting the immune system, first of all, is that something you talk to your patients or their parents about?

BROWN: Well, you know, I wish I could say that drinking a glass of orange juice every day, or giving your child a multivitamin is somehow going to protect them from all of these germs out there. But eating a healthy diet is always a good idea.

But the truth is that the best way to improve your child's chances of not getting sick is to teach really good hygiene. And you know, our mothers were right. It's a good idea to wash our hands. And your child needs to be obsessive about washing their hands because that's one of the most common ways that germs are spread.

GUPTA: You know, it's funny that you say that because people say wash your hands. Oh, yes, I know that. But so many people don't do it. We've actually taught our 14-month-old to actually hold her hands over the sink and wash her hands already. So that's certainly good advice.

And you know, and school can make parents and kids both anxious. And that's something that Michael from Ohio is very interested in.

"Our child entering first grade doesn't like school and is anxious about attending. Any advice for children who feel anxious about attending school" when they're first starting off?

BROWN: Well, you've got to figure out why your child is anxious. Is it for social reasons? Do they not fit in? Are they sensitive? Is there a bully out there who's making them feel sad? Do they feel isolated out on the playground at recess? Or is it an academic reason? Maybe they have a learning disability. And they're having trouble understanding the information. Or maybe they have attention problems.

So it's a good idea to ask the teacher and ask the school counselor to do an observation and really figure out what's going on. If it's a social issue, you could even set up a play date with one of the kids in the class so that they have somebody that they feel comfortable talking to when they're in the school.

GUPTA: Now that's good advice. And also, I guess, just talking to your child, as well, about what specifically might be bothering them.

BROWN: Right.

GUPTA: Good advice. Just ahead, a child's one place for medical help at school might be disappearing. Find out why.

UNIDENTIFIED FEMALE: Secretaries and teachers, providing emergency care to your kids.

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: So you're expected to handle kids who have seizures...

UNIDENTIFIED FEMALE: ...who have fallen and broken something, destroyed their hands in wood shop, all that kind of stuff.

(END VIDEO CLIP)

UNIDENTIFIED FEMALE: Where are the school nurses? Find out just ahead.

First, answer this. The CDC is recommending a second dose of which vaccine for children? That answer after the break.

(COMMERCIAL BREAK)

UNIDENTIFIED FEMALE: Before the break we asked, the CDC is recommending a second dose of which vaccine for children? The answer, the varicella or chicken pox vaccine.

GUPTA: And do you remember that school nurse when you were a kid? Maybe you went to her with an upset stomach, or maybe just trying to get out of class? Well today, things are different. With diabetes and asthma cases on the rise in kids, when school nurses are perhaps needed even more, many districts are going without them.

Elizabeth Cohen has this report.

(BEGIN VIDEOTAPE)

MELISSA SAIL, MOTHER: OK, it's a little chilly. Give me a finger.

ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT (voice-over): Melissa Sail tests her daughter's blood sugar one last time before school starts. Katie has diabetes. And after her mother leaves...

SAIL: Bye, Kate. I love you.

COHEN: This 6-year-old to a great extent is on her own. And that has her parents scared.

Were you surprised to hear that your daughter's school would not have one?

SAIL: I was shocked.

COHEN: But that's the way it is these days at many schools around the country. In California, where Katie lives on any given day, 70 percent of the students don't have a nurse at their school. That's according to the California School Nurses' Organization.

UNIDENTIFIED FEMALE: So tell me, what kind of medications is he on?

COHEN: This is registered nurse Kathy Gabe. She splits her time between Katie's school and five others.

KATHY GABE, NURSE: OK, off I go.

COHEN: Gary McHenry is the superintendent of schools in Katie's district. He agrees that one nurse for six schools isn't enough, but he says there's nothing he can do.

GARY MCHENRY, SUPERINTENDENT: With the funding that we have, we have to put the money into teachers first, safety second. And nursing and counseling services is less of a priority in terms of the money.

COHEN: Statistics and regulations vary from state to state and district to district, but according to a 2004 National Association of School Nurses' survey, nurses take care of nearly twice as many students as they're supposed to under federal guidelines.

GABE: Put that under your tongue. I mean, I love my job. And there are days when I feel overwhelmed because there was so much to do, and not enough time to do it, and not enough answers.

COHEN: These days, at many schools, when a child has a terrible allergic reaction...

GABE: Right.

COHEN: ...when a child has an asthma attack...

GABE: Right.

COHEN: ...who's there to take care of them?

GABE: Our secretaries.

COHEN: So you're expected to handle kids who have seizures, who...

MARY SHEPHERD, SCHOOL SECRETARY: ...have fallen and broken something, have destroyed their hands in wood shop, all that kind of stuff.

COHEN: Katie Sail knows all too well what to expect in an emergency.

KATIE SAIL: I would have to take a shot.

M. SAIL: It should be the nurse that does it, not the teacher, not the secretary, and not Katie alone. It's a constant worry. Constant worry.

COHEN: Elizabeth Cohen, CNN, Walnut Creek, California.

(END VIDEOTAPE)

GUPTA: Cute little girl there. Thanks, Elizabeth.

And let's bring back in Dr. Ari Brown. She's a pediatrician joining us from Austin, Texas. Interesting issue. I mean, one school nurse per six schools. I want to get to some questions specifically about that.

Our inbox now. Anne from Georgia has this question. "What can be done to stop the spread of colds and flu? Would washing tables and door knobs with bleach solutions be the only options?"

Doctor, I mean, you just saw that report by Elizabeth Cohen. There's not enough nurses. What sort of options do they have in schools to prevent these illnesses from arising in the first place?

BROWN: Well, to address the question how to prevent illness, teaching all the kids better hygiene is one important thing to do. So having them cover their coughs, cover their sneezes, and making sure they're washing their hands is a huge start.

It is a good idea to touch countertops and touch them up with a bleach solution, whether it be the doorknobs, or the desks, or the computer key boards. All these things can have germs that live on them for several hours to days, depending on the germs.

And so, cleaning those things regularly is a good start. Addressing the school nurse issue, this is a really big issue. And I will tell you that we had this experience in our elementary school. And the principal said to us, OK, we're either going to lose the school nurse, we're going to lose the gifted and talented teacher, or we're going to lose the art teacher. Which do you want to give up?

And so, our parents actually got together and bought a salary so that we could keep all of them because we didn't want to give anybody up.

But if you don't have that option, you really have to be an advocate for your child. And you have to make sure that somebody is there who will be able to handle an emergency. Teach them some of the issues if you have a child with a chronic medical illness.

And then you also have to teach your child, too, how to handle an emergency and things they need to be looking for if they're having trouble. GUPTA: That's good advice. And maybe some teaching of the parents, as well. I mean, the problem seems to be the kids maybe going to school sick. I mean, how do you know or how does a parent know when to keep them home and when to let them go back?

BROWN: Well, one good rule of thumb is if your child has a fever at night, don't send them to school the next morning. You know, you may be foolishly led to believe if your child doesn't have a fever at 7:00 a.m., you can send them on the school bus. But the truth is as your body temperature is lowest in the morning and highest at night. And so, a child may have a temperature of 99 at 7:00 a.m., but will be 101 at 7:00 p.m. And so, keep them at home if they have a fever at night.

The other thing is most viral illnesses will last two to three days of being contagious, even those symptoms for more than that. And if you have a bacterial infection, good rule of thumb is once they've been on antibiotics for 24 hours, they can head back to school.

GUPTA: We're talking with Dr. Ari Brown. More HOUSE CALL coming up after the break.

UNIDENTIFIED FEMALE: From grade school to college, stressing out is all too common. We've got tips for chilling out when HOUSE CALL returns.

But first, this week's medical headlines in "The Pulse."

(BEGIN VIDEOTAPE)

JUDY FORTIN, CNN CORRESPONDENT (voice-over): Dads over 40 are at higher risk of fathering children with autism, according to a study in the Archives of General Psychiatry. Researchers say a mother's age at childbirth appears to have little impact.

A survey of more than a million women reveals those with dense breast tissue are more likely to develop breast cancer than those with fatty breasts. Study funded by the National Cancer Institute suggests that doctors should consider breast density in identifying patients at greater risk for breast cancer.

The National Institutes of Health says chubby toddlers have a good chance of turning into chubby adolescents. A study of more than 1,000 kids found those who were overweight by age two were five times more likely to be overweight at 12.

Judy Fortin, CNN.

(END VIDEOTAPE)

(COMMERCIAL BREAK)

GUPTA: We're back with HOUSE CALL. More than 17 million students are heading to college this fall. And it's a veritable Petri dish of unhealthy behaviors from lack of sleep, to an abundance of stress, and of course, the common cold. College students are on their own when it comes to staying healthy.

Helping us give them a roadmap today is Dr. Ari Brown. She's a spokeswoman for the American Academy of Pediatrics.

Lots of concerns for college students, Dr. Brown. What are some that you -- you talked about, you know, middle school students. What are your top concerns for returning co-eds?

BROWN: Well, for returning co-eds, it's a matter of making sure that they actually know how to cook. I'll tell you, I went off to college, didn't know how to boil water. I could kill my mother for that.

So making sure they know how to cook is a good idea. Because as you know, the freshman 10 or freshman 15 continues for all of the college years while they're eating dorm food. So that's a big one.

The other is, obviously, healthy habits. And we can talk about sexual activity for a whole other segment. But anyway, that's an issue. And then making sure that they are staying healthy and making sure they get a flu shot's important.

One thing that's important to talk about for college entry freshman is actually the meningitis vaccine. And it is required in some colleges, but it's optional for others. But it shouldn't be optional for your child, because that is the number one form of meningitis in freshmen who are living in dorms. And it's one thing you can do that's so important to protect your child.

GUPTA: And there does seem to be some increase in meningitis cases as well. You know, Dr. Brown, if you write a book of "Co-ed 411", you can recommend cooking classes to all those incoming freshman as well.

BROWN: OK.

GUPTA: Listen, thanks so much for joining us. Really good show. Appreciate that.

BROWN: Thanks for having me, Sanjay.

GUPTA: All right. More HOUSE CALL, coming up.

UNIDENTIFIED FEMALE: Girls and dieting.

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: I definitely feel some pressure to be thin.

UNIDENTIFIED FEMALE: I used to exercise excessively for the amount of calories that I was taking in.

(END VIDEO CLIP)

UNIDENTIFIED FEMALE: The pressure to be thin. Eating disorders. We talked to girls about how they deal with all those images. (COMMERCIAL BREAK)

GUPTA: Welcome back to HOUSE CALL. We're talking about back to school concerns. A big one for many teenagers is if they'll make the cut with their classmates.

Self esteem and body image can take a beating during adolescence. Add to that society's pressures, and that can lead to unnecessary dieting. And a recent study concludes that may lead to dangerous eating disorders.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): Talk to teenage girls about dieting and weight, this is what you hear.

AMY SCHMIDT, 17 YEARS OLD: I definitely feel some pressure to be thin. Not necessarily the like skinny thin.

GINA CARRETH, 16 YEARS OLD: I used to exercise excessively for the amount of calories that I was taking in. I wasn't consuming enough calories compared to how many I was burning.

MOLLY KAYSEN, 17 YEARS OLD: You see the covers and girls who wear like 100 pounds, and they are like 5'5. And that's extremely unhealthy. And I think it's really sad that that's the image right now.

GUPTA: These teenage girls participate in New Moves. It's a program designed to help build self esteem by emphasizing healthy eating and exercise.

Dianne Neumark-Sztainer, author of "I'm Like So Fat," helped found the program and has interviewed more than 2500 teenagers on their dieting habits.

DIANNE NEUMARK-SZTAINER, PROFESSOR, UNIVERSITY OF MINNESOTA: Teenage dieters were at greater risk for weight gain, not weight loss. They were three times as likely to be overweight five years later. They were six times as likely to report binge eating behaviors. And they were two to five times more likely to be engaged in extreme weight control behaviors, such as vomiting and diet pill use.

GUPTA: She says society sends conflicting messages to teens. We're surrounded by supersized fast foods and obesity, yet bombarded with images of super thin models on celebrities.

NEUMARK-SZTAINER: A young girl or a young man really can't stop dieting and gets into a full blown eating disorder. It can be extremely dangerous.

GUPTA: Seventeen year old Annie and Molly say teens should focus on developing strong, healthy bodies and less on dieting because diets don't work.

ANNIE HEIDEMAN: It's just, you know, being careful and like making sure that your body is getting what it needs, you know, and getting that certain amount of exercise.

MOLLY KAYSEN, 17 YEARS OLD: Enjoy your food. Be conscious of your hunger cues. And...

HEIDEMAN: Indulge yourself once and a while.

KAYSEN: Yes, that's very important. Have that piece of chocolate cake.

HEIDEMAN: Yes, definitely.

(END VIDEOTAPE)

GUPTA: Nothing wrong with indulging yourself every now and then. Well, unfortunately, that's all the time we have for today. Tune in next weekend for another edition of HOUSE CALL.

Make sure to e-mail your questions as well at housecall@cnn.com.

Thanks for watching. I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.

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