Scoliosis is an abnormal S-shaped or C-shaped curvature of the spine. It is not a disease. This condition is slightly more common in girls than boys and usually doesn’t cause pain. Adolescent idiopathic scoliosis is the most common type, occurring after the age of 10. It is fairly common and responds well to early intervention and treatment.

Causes and symptoms
The exact cause of idiopathic scoliosis isn’t known, but genes do appear to play a role. The abnormal curvature is not due to heavy backpacks or poor posture.
   
Symptoms include: shoulders at different heights; the appearance of waistline asymmetry; prominent ribs on one side of the back; and the entire body leaning to one side.
   
Many schools conduct scoliosis screenings, usually in middle school. The exam tests for abnormal spine curvatures and detects potential problems. But only an X-ray of the back will actually confirm the condition.

Treatment options:
> Observation: Appropriate when the curve is mild or at low-risk of progression, or if the child is near skeletal maturity.
> Bracing: Prevents some scoliosis from getting worse as your child continues to grow. Several types of braces are available.
> Surgery: Used mainly for severe scoliosis (a curve of more than 45 degrees) or for curves that don’t respond to bracing.

While bracing is the most effective way of preventing the progression of scoliosis, exercise and good nutrition improve overall health. Daily exercise and the equivalent of four to five cups of milk help maintain strong bones. Vitamin D, easily obtained in sunny Orange County, also stimulates bone formation.

Dr. Afshin Aminian is an orthopedic surgeon and medical director of The CHOC Orthopedic Institute. To find a CHOC physician, visit choc.org.


Child car seats
How does yours rate?

A new five-star government rating system will grade child-safety seats on ease of installation.            

The National Highway Traffic Safety Administration says seven out of 10 child-safety seats are either the wrong size for the child or seriously misused. When properly used, child-restraint systems reduce fatal injury by 71 percent for infants and 54 percent for toddlers in passenger cars. In light trucks, fatal injuries are reduced by 58 percent for infants and 59 percent for toddlers.
   
Five stars represent the highest rating and one star signifies the lowest.
   
The U.S. Department of Transportation will rate new models as they’re introduced. For a complete list of new rankings, visit nhtsa.gov and click on Child Seat Ease of Use Ratings, located under Quick Clicks.


Early puberty in girls
Many girls are going through puberty at an earlier age. By age 8, 48 percent of African American girls and 15 percent of Caucasian girls are showing clear signs of puberty, according to Diana Zuckerman, president of the National Research Center for Women and Families.
   
Today, a girl of 7 or 8 who is starting to develop breasts is considered “on the early end of normal,” says Dr. Paul Kaplowitz, author of “Early Puberty in Girls.” Often, a girl follows the genetic pattern of her mother, Kaplowitz says. If a mom has gone through puberty early, her daughter likely will, too.
   
Obesity has an important connection to early puberty in girls, according to a study published in Pediatrics. The study of 17,000 girls found that 6- to 9-year-old girls who had started developing breasts were significantly more overweight than girls of the same age who had not.
   
Scientists are on the hunt for additional causes, and are looking at everything from chemical compounds in cosmetics and plastics, to hormones in meat and milk.
   
Zuckerman says that prenatal exposure to pesticides, hormones and phthalates may be a contributing factor in early puberty.


A shot at toddler vaccinations
Your toddler might be improperly vaccinated, even if she’s had every immunization the government recommends, cites a new study from the U.S. Centers for Disease Control and Prevention (CDC).
   
More than one in four children are out of compliance with U.S. vaccination guidelines, say researchers.
   
The study revealed that some kids get their shots too early. About 3 percent of children had their last hepatitis B vaccines prior to age 6 months, the minimum recommended for that immunization.
   
Other toddlers received their first measles vaccine while their mother’s antibodies still protected them, in effect wasting that dose. Another lapse – getting serial doses too close together – affects 3 percent of children.
   
Outbreaks of vaccine-preventable diseases have been in the news lately.

Were missed doses or mis-timed doses an issue?
   
No. In these cases, the problem was children who had received no vaccinations
whatsoever, says Jane Seward, deputy director of the Division of Viral Diseases in the National Center for Immunization and Respiratory Diseases.
   
One expert advises, “It’s most important that kids get all the doses they’re supposed to have. Providers sometimes have to do a balancing act: avoiding missed opportunities versus giving valid vaccinations. For the 8 percent of children who received an invalid dose, official guidelines call for vaccinations to be repeated.” Some of these children might need re-vaccination before they can start school.


Taking ADHD drugs
Kids need heart test first

Children with attention deficit hyperactivity disorder (ADHD) should have cardiac evaluation and monitoring (including an electrocardiogram) before starting treatment with stimulant drugs, recommends the American Heart Association.

Stimulant medications, like those used to treat ADHD, can increase heart rate and blood pressure. These side effects are insignificant for most ADHD children, but they’re an important consideration for those with a heart condition. Certain heart conditions increase the risk of sudden cardiac death.
   
If heart problems are suspected, children should be referred to a pediatric cardiologist. Once stimulant treatment begins, children should have their heart health monitored periodically, with a blood pressure check within one to three months, then again at routine follow-ups every six to 12 months.

Kathy Sena is a freelance journalist.


Doc Talk

Q: Infants have irregular breathing patterns and make noises when sleeping. How common is this? Kathy, 28, of Fullerton
A: Irregular breathing in infants can be normal. It needs to be distinguished from apnea, which is not normal and potentially very serious. Periodic breathing, which occurs during the first few months of life, is the pausing of breathing for five to 10 seconds, followed by more rapid breathing. It is not associated with cyanosis (turning blue), color changes, bradycardia (abnormally slow heart rate), limpness or a change in the mental status of the infant. Apnea occurs when an infant does not breathe for 20 seconds or more. Plus, the infant can have color changes, limpness or mental-status changes. Infants will make different noises while sleeping, but should be comfortable and not in distress. A grunting or groaning noise may signal a problem and should be evaluated by a doctor.

Q: How can I get my toddler to share? Lisa, 31, of Anaheim
A: With toddlers, sharing is a very new and difficult skill. A 2-year-old does not have the cognitive skills to understand the concept of ownership, let alone sharing. But, you can support your child in mastering this concept in several ways:
> Model sharing in the home. Share something of yours with your toddler. Explain how you are sharing.
> Catch your child sharing. Provide positive feedback.
> Identify potential disputes. Make sure there are plenty of toys for children to play with, and try using a timer for taking turns. Also, try engaging children in playing with toys together. n

Dr. Daphne Wong is on staff at Children’s Hospital of Orange County (CHOC).


Back-to-school strategies

This month, we want to help your ADHD child succeed in school, often the most challenging aspect of your child’s life. The rigid structure and emphasis on being quiet and still can be torture for a hyperactive child. Even when she tries her hardest to pay attention to homework instructions, many are forgotten by the time she reaches home. The most successful school-survival tips for an ADHD child are what parents use to help any child succeed in class and with homework – just kicked up a notch or two:

1. Find a structure that works and stick with it. Set a specific time each day (make it the same time every day) for homework, ensuring that enough time is set aside to complete assignments. If possible, avoid scheduling this time late in the evening to prevent tiredness-fueled meltdowns.

2. Specify a homework area, preferably away from all TVs, music and videos. Stay nearby to remind her to stay on track.

3. Give breaks; offer praise and rewards. Any kid will get tired while doing homework, so short breaks can keep him focused. Praise and rewards will help to maintain motivation.

4. ADHD children need to move. Make homework breaks physically active. Give her time before school, even if it’s just riding her bike to get there, to maintain calm in the classroom. Let her teacher know that frequent breaks will help her stay focused.

5. Divide tasks into smaller steps. Once you’ve given your child one instruction and enough time to complete it, have him report back to you. Move on to the next step when the first one is completed correctly. n

Elisabeth Handley is a regular contributor.