Archives for May 2018

Nina Agrawal, MD, FAAP

Dr. Nina Agrawal, MD, FAAP is the Medical Director of the Child Advocacy Center at Lincoln Medical Center in the South Bronx, where she practices child abuse pediatrics and runs the Center’s Community Pediatrics residency rotation.  She is member of the NYS AAP Chapter 2 and 3 Gun Violence Prevention Committee.

NYS AAP Chapter 2 and Chapter 3 members:

For the first time since the shootings at Sandy Hook elementary school, I feel hopeful.  The next generation is standing up for kids everywhere – rural, suburban, and urban.  They are standing up for the countless children traumatized every day by gun violence – directly and indirectly.

We had over 100 medical students, pediatric residents, and practicing physicians from programs all over NYC participate in the nation wide March for Our Patient’s Lives on March 24th.  Kudos to Hofstra medical students for coming out in huge numbers! (https://www.youtube.com/watch?v=eFWIXT6_IiM&feature=youtu.be)

We must continue to stand up and speak out!  As pediatricians, we are a trusted voice and can save lives.  Here’s what you can do NOW:

1. LEARN
   1. Gun violence is a public health crisis. This is not politics.  This is about policies that keep children safe.  Gun violence is now the 2nd leading cause of death in children and is on the increase.  Every day we do nothing, 7 more children die.
   2. Gun violence is preventable. We need research and data to support effective policies.  Because of the Dickey Amendment stating that “no funds could be used by the CDC and NIH to advocate or promote gun control, we are 22 years behind in identifying evidence based solutions.  We need Congress to repeal the Dickey Amendment and appropriate $50 million to the CDC to do their job.
   3. We are promoting gun safety not gun control. This is similar to past highly successful public health campaigns such as Safe to Sleep and Motor Vehicle Safety.  Because of “Back to Sleep” and car seats, we have dramatically reduced deaths from these preventable injuries.  We need to do the same for gun violence.
2. CONNECT
   1. We can’t do this alone. There are lots of opportunities to get involved.  Whatever you can give – a day, a week, a month – It all makes a difference.
   2. Connect with gun violence prevention advocacy groups like Moms Demand Action or the new Gun Violence Prevention Committee of NYS AAP Chapters 2 and 3.  Other groups always welcome white coats!
   3. Create dialogue with other health professionals. Offer to speak at noon conferences, grand rounds, etc.  Connect with speakers and ask them to present at your institution.
3. ACT
   1. Raise awareness about the need for research – on a state level and on a federal level.  Most physicians don’t know about the Dickey Amendment. Repealing the Dickey Amendment has bipartisan support.  There is proposed legislation to create a NY State firearm research center.
   2. Put a face on gun violence. Tell your story about a patient or an experience.  Legislators have the stats but don’t have the front line experiences we have.
   3. June is gun violence prevention month.  June 2nd is wear orange day. Orange is the color for hunters, warning people not to shoot.  Host an event. Can be large or small.  We are happy to help you!

Stay tuned for a gun violence prevention summit in NYC on June 23rd organized by NY Docs – A coalition of advocacy groups dedicated to improving health for all.  To learn more, feel free to contact me.  We will be educating health professionals on policy advocacy and giving you the tools to take action.

Please read the attached letter from a 9 year old advocating to keep kids safe from guns.

In unity,

Nina Agrawal, MD
ninaagrawalmd@gmail.com

Heather Brumberg, MD, MPH, FAAP

Shetal Shah, MD, FAAP

This blog post was originally published as an Opinion-Editorial piece in www.lowhud.com.

(Dr. Shetal Shah, MD, FAAP is a neonatologist at Maria Fareri Children’s Hospital.  He is NYS AAP Chapter 2 Vice President and Chair of the Legislative Committee.  Dr. Heather Brumberg, MD, MPH, FAAP is Director of Regional Neonatal Public Health Programs and Medical Director of the Lower Hudson Valley Perinatal Network.  She is NYS AAP Chapter 3 President.)

Influenza has a public relations problem.  Though often perceived as a mild inconvenience, this past influenza season, commonly known as “flu,” demonstrated how serious the virus can be, infecting an estimated 34 million people nationwide and killing almost 4,000 this year.

As pediatricians in the neonatal intensive care unit, we cared for several babies whose influenza was so severe they required mechanical ventilators to help them breathe and intravenous medication to help their hearts beat stronger.  Our patients survived, but about 150 other children weren’t so fortunate.

With the increased attention this year’s flu season has received, the New York State Legislature is considering a bill (A1230a/S6346) to increase flu vaccination rates in preschoolers – the pediatric population most likely to harbor, and get seriously ill from influenza.  The bill would require infants, toddlers and young children who attend certain daycares to obtain an annual flu shot.  The measure being considered in Albany, which is similar to existing legislation in New Jersey and Connecticut, is highly effective at protecting kids from flu’s most severe complications.  In Connecticut, the regulation reduced flu-associated hospitalization in young children, and in New Jersey, preschool rates of flu immunization increased to 88 percent in the law’s first year.

The numbers from this past flu season define a public health epidemic.  In New York State, there were about 120,000 cases of influenza this past season, which doesn’t include additional undiagnosed illness.  Almost 12,000 people have been hospitalized and roughly 8,300 children under 5 years old were infected.  Eight children in our state died.  Fortunately, immunization against flu is an effective and safe means of protecting children from influenza.  Even in years when the vaccine doesn’t confer as much protection as it could — this year’s vaccine was about 30 percent effective – it still minimizes the risk of the most severe complications from influenza, including hospitalization and death.

The Centers for Disease Control recommend an annual flu shot for all children and adults with rare exceptions.  Immunizing young children is paramount, because their immune systems are inexperienced, not having encountered many flu strains before.  These children are therefore more likely to get critically ill from influenza.  Children in the close confines of daycare also serve as reservoirs of disease – passing the virus to other young children, siblings, their parents and grandparents.

While preschoolers are roughly one quarter of the child population, they represented almost 40 percent of all pediatric deaths from influenza from 2004-2012.  Unfortunately, flu vaccination rates in children are shockingly low compared to other recommended vaccines.  In 2014-15, only two thirds of New York’s children received a flu shot, while greater than 90 percent were immunized against Hepatitis B.

Unfortunately, there are opponents who object to any new regulations, seeing scientific-based policies as an infringement of personal choice, combating scientific fact with passion and volume.  These arguments were made when sates introduced seat belt laws, which the National Highway Transportation Safety Administration estimates save 10,000 lives annually.  They were made when infant car seat rules were introduced, which save 250 babies per year.  Bike helmet laws, which reduce head injuries by 40 percent, prohibitions on smoking in airplanes and other vaccination rules have always been initially met with dissent, despite having roots in public health data.

Reinforcing our protection against influenza for children in daycare does not mandate flu vaccination.  Parents who choose not to immunize their child have a right to do so.  However, this right should not allow them to be in areas where disease can be easily transmitted.  This is especially true for a highly infectious disease like flu, which can infect children even before the initial child is sick.  It would also prevent passage of disease to children in same daycare who are too young to get vaccinated, like newborns.  Parents who disagree with school vaccination requirements have for years chosen to home school there children.  Similarly, parents who disagree with these medically-supported proposals can seek alternative child-care arrangements.

Immunization remains one of our country’s greatest public health success stories.  Failing to take practical steps to protect toddlers and young children from a highly infectious, potentially serious disease would represent a missed opportunity for New York State.

This blog post was originally published as an Opinion-Editorial piece in the Huntington Patch.

(Dr. Eve Meltzer-Krief MD, FAAP is a pediatrician in Huntington and member of the NYS AAP Chapter 2 and Suffolk Pediatric Society.)

Cuts To Farm Bill Will Affect Hungry Children On LI, Doctor Says

Dear Editor,

As a pediatrician I feel compelled to speak out against the proposed cuts to SNAP in the Farm Bill, H.R.2, which is currently up for a vote in the House.

SNAP is the Supplemental Nutrition Assistance Program.  It is the most effective domestic U.S. hunger safety net program and nearly half of its recipients are children.  Over one million children in New York State receive benefits from SNAP.  Cuts to SNAP will adversely affect children in the nearly 22,000 households with children that participate in SNAP right here on Long Island.

SNAP delivers critical support to vulnerable families to ensure that they can put food on the table.  Children who live in households that are food insecure are likely to be sick more often, recover from illness more slowly and be hospitalized more frequently.  Lack of adequate healthy food can impair a child’s ability to perform well in school and can lead to higher levels of behavioral and emotional problems from preschool to adolescence.

SNAP is reauthorized under the Farm Bill, legislation that renews federal agriculture, trade and nutrition programs.  At present, SNAP benefits are not enough to provide funding with the resources to obtain an adequate healthy diet, and they should not be cut further.

No child should have to struggle with hunger and food insecurity in our country.  SNAP serves as a critical support for the health and well being of children and it’s funding should not be cut in the Farm bill.