Thursday, December 15, 2011

The Importance of Medical Play

Last week, my 3 year old, whose asthma is generally very mild, needed a few treatments of his albuterol inhaler. Because he is unaccustomed to having the spacer device on his face, the process of administering the medication was a bit of an ordeal. When I say a bit of an ordeal, I mean kicking, screaming, tears flowing, hyperventilating -- you know, nothing I can't handle. I finally got the puffs in him, and swore to myself that we weren't going through that again. By that point, we were already late for daycare, so I left the inhaler and spacer on the coffee table and whisked the kids off to school.

That evening, as I was preparing dinner, I heard a strange musical noise, and turned to find Son #2 using his spacer as a vuvuzela. Here was the same child who only that morning was so vehemently resisting his treatment, now dancing around the kitchen with his spacer and inhaler attached to his face.

The sound might have been as annoying as anything coming out of the World Cup stands, but it was music to my ears. Left to his own devices, my child overcame his fear of the unknown by doing what children naturally do -- playing. A second treatment later that evening went remarkably smoothly.

Medical play allows children to gain familiarity with diagnostic procedures in a non-threatening environment. This type of play is especially important for children who may be undergoing chronic treatment for conditions such as asthma, immune deficiency, or cancer. However, medical play can also assist in preparing children for one-time procedures or treatments, such as allergy skin testing or vaccinations. It doesn't require a great deal of specialized equipment- a simple store-bought toy doctor's kit and a stuffed animal are a great start.

There are also a variety of excellent books written for children who require a single routine doctor's visit or chronic medical care. A quick search online or at your library or local bookstore will yield a wealth of resources.

If your child has an upcoming physician's appointment or procedure scheduled, think about incorporating medical play before, during and after the visit. It just may make things easier for everyone. Just ask my spacer/vuvuzela-playing son, who is now breathing easy.

Thursday, December 8, 2011

Want to Decrease Your Child's Risk of Pet Allergy? Better Act Fast!

The past few years have seen increasing interest in potential strategies to reduce the risk of allergy and asthma in young children. One particularly popular topic has been that of early pet exposure potentially decreasing the risk of animal allergy. Indeed, I am often asked by parents of my young patients if I recommend adding a furry pet to the household. However, it has been unclear how early in life the pet exposure needs to occur in order to modify risk. 

A recent analysis of data from the Detroit Childhood Allergy Study sheds some light on this important question. It was published in the July 2011 issue of the peer-reviewed medical journal Clinical & Experimental Allergy. (Clin Exp Allergy. 2011;41:920-922)

Annual interviews from 1987 through 1989, and follow-up interviews at age 18 years, were used to assess study subjects' exposure to indoor dogs and cats. After analyzing pet exposure during the first year of life, specific age ranges, and cumulative lifetime exposure, here's what the researchers discovered:

Cats: For both boys and girls, exposure to household cats during the first year of life was associated with a decreased risk of sensitization to cat at age 18 years. The relative risk (RR) of sensitization was 0.52 compared to children without cat exposure during this time. However, there did not appear to be benefit conferred from cat exposure during later time frames.

Dogs: For both boys and girls born by cesarean section, exposure to household dogs within the first year of life was associated with decreased risk of dog sensitization at age 18 years (RR = 0.33). However, if delivery method was not taken into account, the reduction in risk was significant only for boys (RR = 0.52). Sorry, girls!

Bottom line? Early exposure to household cats and dogs does appear to modify the risk of future hypersensitivity (there is actually some evidence to suggest the tolerance induced during this early period may be long-lived), but the window of opportunity is very small. The benefit does not seem to extend to exposures beginning after the first birthday. As most parents are disinclined to bring a new baby and a new pet into the home simultaneously, it is likely that the main beneficiaries of this protective effect are children born into households where Fido or Fluffy are already firmly established.