(00:00:00) Our Guest this afternoon is dr. Tom Norris whose medical director of the outpatient department at Children's Health Center in Minneapolis, dr. Norris is also a member of the American Academy of Pediatrics and he's involved in their efforts to promote the UN sponsored International year of the child we want to talk about iyc and we'll do that a little bit later in the program to First welcome. Dr. Norris and I'd like to begin by picking up where Dan left off in the introduction to the segment of the program and asked you to talk a little bit about whether or not we are really seeing a Resurgence in certain children's diseases or if in fact it's still pretty isolated in the that maybe the media is making more out of it than it really (00:00:42) should I think there's no question but that the immunization recommendations by the health department are taken to curb. What is a growing problem. And that is that several years ago was thought that polio was virtually non-existent and over the last several years there have been a significant increase. The numbers of people across the country who have contracted polio. It seems as though the general population is immunized but here and there there are small groups of people who remain unutilized people who are moving into the country from other countries people who for various beliefs have decided not to have immunizations and now it's becoming obvious to them that it is important to prevent this problem because they remain susceptible to it. (00:01:25) So it's a it's a problem and one that that you as a physician who tends to Children is concerned about then (00:01:32) yes quite (00:01:32) definitely. Is there one particular reason that that you see as this this Resurgence in children's diseases. Is it just that parents are becoming more relaxed and taking for granted the fact that these diseases no longer are a big threat. (00:01:50) That I think is part of the problem. And once you lose sight of what can happen and having lived through a polio epidemic or live through a measles epidemic you lose sight of in your immediate knowledge. What is going to happen. If your child should contract one of these diseases another is that it's been very difficult for various agencies to enforce legislation or even have legislation passed which might permit immunizations to all children as a consequence often whole communities will have very low numbers of people who are even eyes and therefore their remain susceptible to the problem. (00:02:29) What what can be done about that other than what the health department is doing encouraging and just as a bit more of information in that regard. I spoke to somebody to Health Department a couple of days ago about their effort to get the polio vaccine into Amish communities in the state and it seemed to me that about all they were able to do is simply urge they are not able to go in and say you must do this We find that frustrating thing at times. (00:02:54) Of course. I'm in a situation where people are coming to me for immunization. So I'm in a different picture what I understand they're doing in some communities is they're going to door-to-door and offering these immunizations and when they're made available people are accepting though. One of the major concerns that I have is the parents often don't know whether their children have been adequately immunized or not. They sort of assumed that the physician has the records and they The Physician is responsible for knowing what the health status of the child is and as a consequence sometimes children are inadvertently on immunized. It's very difficult at times to get these records from people and as a consequence, we may not bring them up to date even though they're sitting in her office. So one of the concerns we have is the parents acquaint themselves with what are the recommendations and try to take steps to make sure that their children have the Asians the schools are being asked to enforce immunization laws on school entry and I think that that's going to make a significant difference. But whenever the schools are put into that position they're being asked to enforce a law that they don't necessarily understand and that makes them in conflict with the parents. And so some parents could help by becoming involved in supporting the school is they are trying to implement this long. (00:04:17) What are the standard set of immunizations that child I suppose starting from birth. Is it a long string of shots and things like that or is it a relatively short series of immunizations? (00:04:31) There are two different theories. One is the primary series that is used in all children starting at 2 months of age and finishing at 18 months of age at 2 and 4 months of age the diphtheria whooping cough and tetanus immunization is given along with an oral polio at six months of age at Oral polio is given At 13 to 15 months of age the measles mumps and German Measles shot is given and then at 18 months of age it diphtheria whooping cough tetanus immunization in the oral polio is repeated. If you then wait until school there is another diphtheria whooping cough intentness. It is given in the oral polio. And if you've missed those immunizations somewhere along the line, I don't know what your immunizations status is. There is an abbreviated schedule so that you can have to immunizations at roughly 2 month intervals and then nine months to a year later have a follow-up that will bring you up to (00:05:26) date. So it's not dangerous than if a person has these shots or he gets these vaccinations more than once if say a youngster was vaccinated at the age of two and then parents didn't have records and that aged of five or six when I started school. They weren't sure so they it's all right for them to go ahead and have some of these again (00:05:47) it's being recommended that the immunizations Repeated if it's uncertain that the child ever received them in the first place and it's not thought to increase the risk of the immunizations to do that. (00:05:59) What about tetanus? It's my understanding that even adults are encouraged to get tetanus shots when they suffer an injury, like stepping on a nail or something like that. That's not something that stays with us for life than the immunization that serum builds up (00:06:14) tetanus is one of the best immunizations that we have and when you have received the primary series 99.99% of people are adequately immunized it's unknown how long this lasts but it's been shown that people who are immunized and World War to maintain their antibody tires 20 years later. The recommendations are that the immunization be repeated every 10 years in order to assure that everyone receives adequate immunization. And if you have a serious injury, you should have a repeat immunization at five years. (00:06:47) So it's it's not necessary to get a shot. Just every time you might suffer a nail injury or something like that. That might be a have rust on (00:06:56) it. That's correct. Okay. (00:06:59) Well that seems to pretty well cover the immunization part of it. Unless Dan has something (00:07:03) more. Yeah, I do rich. This is the two of you were talking about the patterns of immunization time. I was curious about the cost of these various shots and things this is of concern to some people who might want to try to cut down on visits to the doctor's office. What kind of idea can you give us as to the cost of these immunizations? I think the immunizations cost vary considerably from Center to Center. The State Health Department is making the immunisations available through their various Public Health Facilities free of charge. And so that should never be a reason not to have your child immunized and if you call your county health or State Health Department, they'll be able to inform you of the nearest place where you could receive immunizations for your child. What about the risk factor times some of the immunizations you indicated are more effective than others techno tennis being quite effective. What are some of the risks associated with them? Every immunization has a risk along with it and some of the risks are considerable. I think we've all heard of children who have acquired polio after or an association with polio immunization the risk of acquiring polio in that situation is roughly 1,000 or less the risk if you had the virus from an infection infected person with polio the same thing with measles the problems that are associated with measles are reduced by a thousand times. When you have the immunization that doesn't mean to say that the measles immunization doesn't have problems. It means that it reduces your chances of being blinded or made deaf or have some problem with the way you think as a Application of having had measles same thing with the diphtheria whooping cough and tetanus each of them has some pain associated with it and some reactions but the reactions are thought to be far less severe than the disease itself. We wouldn't be in the business of recommending immunizations. If we didn't think that it would be helpful rather than harmful (00:09:08) one one aspect of Children's Health that always startles me when I hear reports or studies about it is the effect of stress or the role that stress plays in the lives of young children. It seems like we're conditioned to think of adults experiencing stress and their jobs, but we don't very often it seems think or maybe I don't at least think of youngsters suffering from long-term effects of stress, and I wonder if you see that in your practice at Children's and might be able to shed some light on some of the causes. Is it a serious concern of yours as a physician who treats children? (00:09:47) The problem of dealing with stress is something that we as Physicians live with at all times and we know that any time a person comes to see us in the clinic they have the illness that they're concerned about in their child, but they also have something that's happening in their lives that make them come in at that particular moment. It may be that they believe that the child is somehow going to be adversely affected by the illness or the problem at hand and hopefully it's because they believe that the physician can be of help when they come to him. But in addition there are major stresses that occur on a day-to-day basis families who are undergoing separation or undergoing moves families where the husband or wife have had poor childhood experiences themselves and are having difficulty dealing with their children when they see them getting into the same situations they experienced. They may recall illnesses which they saw that resemble their child's and come to us seeking seeking help in relationship to the other illnesses as well as their own child. So stress is always a problem. There are some people who have looked into this further and believe that when a family is in stress such as a move or a divorce or or perhaps even something as simple as school ending that the likelihood of a child having an accident or having an illness sickness in and of itself increases and some people have gone so far as to suggest that some of the illnesses that we worry a great deal about such as leukemia may have some association with stress. I know very little about this and I'm not prepared to talk about it, but I think that stress is a very important event and we see it every day in our offices (00:11:45) is there is there That that parents might do to to at least be aware of that in their own lives and raising children things that they can do to either lessen the stress or if the stress is there and the situation is there and they have to deal with it there something that might ease the situation to some degree. That's a pretty broad question. I (00:12:06) really yeah, there's no easy formula for saying to someone get in touch with your feelings and find out where you are. But I think that when you feel this comforter or tension or feel nervous and upset that if you take some time or allow yourself to have the time to sit down and think about those things that are happening in your life and think about how they are affecting you and think how they might also be affecting your child and and talk with them about those issues. You may take the first steps to addressing stress and reducing the effects or impact of stress and both apparent in the child. (00:12:42) This year which is almost half over with has been declared the international year of the child by the United Nations and member nations are to one degree or another marking that year and you I know have been speaking around the state at certain times about iyc. Tell us a little bit about it. We haven't heard a whole lot about it so far this year. (00:13:07) I think that a lot of people haven't heard about it. I don't understand how something associated with the United Nations going to have an impact in their lives here in this country. And I think that many people assume that the United Nations is for the underdeveloped countries of the world are relates to some place other than ourselves. And what we've done is we've looked at some of the issues which we think are terribly important on a worldwide basis issues related to the availability of food and the proper use of nutrition the immunization issue. We've already Develop issues related to health education on how families can work to understand how to use Health resources in a way that doesn't increase the cost. But rather allows them to assume a far greater sense of responsibility for their own care another issue that's of importance in this country as accident prevention and right of a child who having a safe home environment one, which will protect him against injury. There are many other issues on a nationwide basis the right to adequate education the right to a home there whether its freedom from abuse the right to Family Planning information and I'll birth control information all of these things have a very important part in the international year of the time (00:14:35) one one thing that popped into my mind. We were talking about a safe environment in the home. Imagine that safe environment. Tends to the automobile parents some parents have more success than others in getting their children to wear seat belts. What do you suggest for you is a method or methods of getting children to use seat belts because often it's not uncommon to drive down the freeway or in a city street and see a child propped up on the dashboard three or four inches from the windshield or perhaps on a Sunday evening coming back from the lake. There's a baby or a youngster lying on the rear deck just behind the rear window and thoughts go through my mind at least of what would happen to that child if that car had to stop or swerve quickly. What are some things that parents can do to to make it the automobile a safer place for a child who really doesn't have much control over what goes on inside that (00:15:34) car? I think that first of all the risk is really there and the notion would be to imagine the impact of a child hitting a windshield should occur abruptly stopped coming from a speed of 30 to 60 miles an hour being very similar to the impact that a child would experience. If you fell out of the fifth to the 11th story window of a building incredible forces are involved and when you think of the pictures of shoes lying and Pavements for someone has been hit by a car and been propelled right out of their shoes, you can begin to imagine the degree of force. It's thought that by using safety restraints you can reduce the incidence of accidents considerably and the problem is how to get which you raised which is how to get people to use on several things have been proposed one is that you give infant restraints as baby shower gifts to women during pregnancy or make sure that when the mother takes the child home from the hospital She takes the child home not in infancy. But in a one of the safety restraints that's available for children that size. I think that you should familiarize yourself with the kinds of restraints which are appropriate and there are Library sources and every Physician's office has this information. Unfortunately, the car manufacturers don't always have the information but General Motors has created some infantry streets which are very useful then comes. What do you do when you haven't done that or what do you do when your child starts placing demands on you? That's a get me out of here. Get me out of the restraint and at that time if you deal with it the first time in our firm and patient and perhaps stop the car and wait until the child settles down or insist When the Children get into the car that you're not going to move until they are buckled up or if they unbuckle after you've gotten going you pulled to a stop and wait and are very firm and direct and Nation I think that you can most the time get the children to use the restraints it has to be something where they feel secure and comfortable where they develop it as a habit just as you as or I might buckle up and it's up to the parents to patiently work with them in that regard auto accidents. Tom rank, very high among threats to Children's Health. Is that right? That's correct. They're like isn't Auto Safety one of the most perhaps a number one. I'm thinking of asking. What is the list of the significant Health threats to Children? What are the number one through five causes of children fatalities can fatality Czar things of that nature what I hear you saying is what are the most common preventable? Yeah causes of childhood death and you might immediately think of heart disease or cancer, but it turns out that accidents are among the most common the automobile. I think are extremely important accidents within the home rank very high electrical cords and electrical outlets that are unprotected or where a child sustains a burn from chewing on the cord the kitchen where there are poisons stored under the sink can be a very dangerous place for a child. It's not unusual for a mother to report to me over the phone that once she gets on the phone talking to me her child goes running off to the kitchen and Dives under the sink for his opportunity to play in the things that are otherwise forbidden and if those things happen to be lemon oil or some other form of furniture polish, that is looks like fruit drink it wouldn't be unreasonable to expect him to give it a little try and they can be very dangerous playgrounds and playground safety are quite important in many children play an unsafe area such as the street bicycles and Wheels skateboards. Ranked very high in Minnesota. I think that water safety has to be emphasized and the issues related to drowning and self-rescue should be considered. It's not unreasonable for a child six months of age to be taught basic skills that staying afloat so that they might be more likely to survive a water accident and I think it's important for all adults and children to learn at least the minimum of water safety before they go near the water in the area of poisoning accidental poisoning that you mentioned urban areas have pretty good services available for dialing quickly and getting good poison information. What about rural areas? (00:20:15) What do you know about that the services available to (00:20:17) parents in those areas where a child may accidentally swallow something that could be very toxic. I think the First Resource should always be to call the physician who is in your who usually go to for healthcare and then the he can For you to a poison control or poison information center after you've talked with him or her (00:20:42) and there are also some things that an individual can do some emergency things is to aren't there. What are some of those? (00:20:51) Well, probably one of the first things would be to acquaint yourself with basic safety and various Publications such as Consumer Reports have run articles on child safety and accident prevention in the home and are available in the library. The next thing is To have information about who to call near the telephone so that in a panic situation you can call should learn those things that you have around the house which might be dangerous to a child and lock them up. There are plants and medicines that sometimes I brought with grandparents and you have to be very careful to identify those and be sure that they are kept safe (00:21:37) you mentioned electrical cords a few minutes ago to and that seems like almost an impossible thing to to get out of the reach of a youngster. What do you suggest for for that kind of thing? You can put poisons up and lock doors and things like that, but it's harder to do (00:21:52) that. Well, the first thing is to be observant of your child when he starts exploring the outlet teach them that it's a know by taking his hand away if it appears that he's going to and he probably will explore it again. Try to make sure that the small metal objects that he might try to stick into the openings are not available. Are our plates which you can buy which will automatically lock when the outlet is covered. And when the when the outlet is not being used there's some question about the ones which plug-in but they would be better than nothing and might give you a few moments to notice that your child is playing with the outlet before you got into it by taking it out. The cord themselves should be inspected so that the frayed and and battered cords aren't around the house. And then again, the child should be taught that that isn't something that you put in your mouth and chew on and the specific times that you would worry would be in the first three years of life when they're crawling around on the floor a lot and are going to be behind things are in back of things exploring and then you just have to teach them by taking them away and telling them no and going through the things that parents usually know how to do with their children. He's not (00:23:01) in the few minutes that we have left. I'd like to go back in the direction of the international year of the child and I know that you for a Time worked with Indian communities in New Mexico, I believe I'm wondering what if anything is being done with Children's Health in the Indian Community in the Twin Cities. And also in other parts of the state it I know from some very short brief research that at least the the infant mortality rate among Indians in the state of Minnesota is considerably higher than among white children. I'm wondering if Children's Health also suffers in the Indian Community in Minnesota from what you know, (00:23:49) It's really hard to call me an expert in this although many of the people with whom I work our Indian and is true than in the southwest. I work in among young people both Pueblo Navajo the kinds of health problems. I see here are those that are in all populations? And that is that parents sometimes have trouble trusting the health providers and have a hard time bringing their children to see Physicians because they don't always believe that Physicians or nurses are going to be helpful to them. This basic mistrust has a great impact on whether or not they're going to make themselves come in another is that The people who live in several communities are very poor and don't have access to food and basic nutrition and it's been shown over and over again that it isn't what you know that leads to what you feed your child. It's has to do with dollars and cents and just not having the right food available because you can't afford it becomes a very serious health problem. The incidence of dental decay that comes from drinking soda pop is a new problem in many populations in this country and routine dental care and health practices haven't appeared to receive the same kind of Interest as providing snack foods and beverages to children. So I would have a hard time generalizing about any particular group such as the Indian people, but I think that the problems that they face are those that we all face. Who do we trust and how We get access to those things that we know are good. (00:25:41) How do you get get around get through that trust issue where you work? (00:25:48) It takes time and it takes patience. You have to be willing to listen to people and learn from them. What they think is important rather than sitting and thinking that you know, all the answers be aware and sensitive to nuances and differences between yourself and any of the people with whom you're working and and enjoy the opportunity to learn some of those differences so that you can I at least can expand my range of how I work with people. So the first thing is to learn to trust them and learn to know what they're doing and what they believe as they're trying to do the best they can to raise their children and then become An expert someone who can be helpful to people with the wide variety of problems. I think as a physician, I am lucky because I have some tools that I can use in the way of curing some of the illnesses that people have and that allows people to trust me were readily than if I didn't have those skills, but the important thing for me is to use my skills to develop a sense of sharing with the parents. So we work together for children rather than me dispensing uphill or a drug to make them better in a way that that isn't sharing at all, (00:27:08) even though I would imagine that at least for some Physicians that must be a great Temptation since they've just spent several years learning all the answers or at least maybe thinking that and it must be a test of patience at least for a time to do that (00:27:22) now fortunately a lot of people go into medicine are good Learners and they can continue to learn but not all do I think that that of the Professionals that I work with the vast majority are very concerned about having an impact on the family and children that they work with and are interested in creating motion and social change, and I think that it is the most highly skilled part of our job. (00:27:49) Dr. Tom Norris who is medical director of the outpatient department of children's health center in Minneapolis. Thanks very much for being with us this noon. Thank you.