Another word about lead

Lead exposure for our children has been in and out of the news for a few years–now back in, unfortunately.  I have written about this previously.  21 school districts statewide have recently reported elevated lead levels; several of these are local.  Overall, approximately 800 locations are covered by updated regulations adopted last summer by the state Department of Education for testing of school drinking water.  In Toms River, Pine Beach, South Toms River, West Dover, and Washington Street Elementary schools all had a few locations within their buildings with unacceptable lead levels.  Fortunately in each of those places, no contaminated areas involved student drinking fountains but rather only cleaning and janitorial stations.  Unfortunately, previously in Brick Drum Point, Emma Havens, and Herbertsville Schools also had these problems with the first 2 including some drinking locations.

In all of the above instances, school authorities have been quick to note the problem and commit to prompt correction.  In the short term this involved isolating the contaminated fixtures and avoiding the use of water from them; long term requires replacing old pipes and plumbing fixtures.  And the state has added an additional $10 million  (on top of a like amount appropriated last year) to fund those capital improvements.

So–reason to remain vigilant and concerned.  No cause for alarm.

I’d like to close with 2 additional points.  Presently elected officials on the national level have committed to comprehensive review of government regulations affecting so much of business and public life.  I say–great.  New sets of eyes can bring fresh perspective; things change, information is updated, and often we can find new, better, and maybe even less expensive ways to do these things.  But we must be careful to not –literally–“throw out the baby with the bath water.”  Lead exposure illustrates that there are often very solid reasons behind plenty of these rules, and many people–in particular vulnerable children–are protected by those regulations being on the books.  In life it has been my experience that some people– who’s financial interests may be adversely affected by those guidelines and mandates– at times, shall we say, may have difficulty fully appreciating those virtues.  As a pediatrician who has dedicated over half of my life to children’s health, I, for one, am grateful that people both at the state Department of Environmental Protection AND at the federal Environmental Protection Agency are there to help look out for those kids.

And one more thing.  Nationally we have become more aware of the issue of lead toxicity since the events in Flint, Michigan in 2015.  There, the problem was uncovered thanks to the dogged persistence of a local pediatrician, Dr. Mona Hanna-Attisha–an Iraqi immigrant–on behalf of her patients.  Dr. Hanna-Attisha is a credit to the medical profession and our nation owes her a debt of gratitude.

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Osgood-Schlatter, Sever’s Apophysitis

Children’s skeletal growth occurs at the growth plate or apophysis.Typically, the apophysis remains “open” and growth continues for girls until age 13-15 and boys 16-18.  For a year or 2 before growth plate “closure” that child will experience maximal growth velocity.  2 large tendons–the patellar tendon in the knee and the Achilles tendon in the heel–insert into the growth plates of the respective bones below that joint (tibia for knee and calcaneus for heel).

During that period of maximal skeletal growth those tendons are actually sliding along the bone at the site of the growth plate over time as it lengthens. This is necessary so that the tendon remains in proper anatomic position as the bone elongates.  Specifically, as the tibia grows longer at the top, the patellar tendon slides upwards and as the foot grows longer at the calcaneus(heel) the Achilles tendon will slide backwards. Microscopically, this occurs as the fibers on one side of the tendon tear free and new ones grow and attach on the other side so that the tendon grows/moves in the same direction as bone growth.  This process at the growth plate (apophysis) during accelerated growth in adolescents can cause inflammation and pain at the site called apophysitis.  Knee pain apophysitis is called Osgood Schlatter’s disease and at the heel it is called Sever’s disease (I’m still not sure if “Sever” should be pronounced as rhyming with “weaver” or “weather,”, but anyway).  The pre-teen or teen will complain of chronic pain that is worsened by running, jumping, or climbing stairs.  The only finding in OS may be  a painful red lump below the kneecap, affects about 20% of athletes, and in about 25% will be bilateral.  In Sever’s the child will have tenderness on the inside and outside of the heel, has a 2-3:1 male;female ratio and may be bilateral up to 60% of the time.

Both conditions are usually self limited in that they will resolve when the child achieves adult height and the growth plates close.  For both conditions, usual treatment consists of proper stretching before activity and ice the affected area afterwards.  Ibuprofen is good for pain avoid caffeinated beverages on ibuprofen); padded knee pad for OS and cushioned shoe soul inserts for Sever–either “off the rack” or custom made orthotics by a podiatrist are often helpful as well.

Many children can “play through the pain.”  Some may choose a period of rest, or changing sports to relieve pain (swimmers don’t have these problems).  Both of these conditions tend to be mild, uncomfortable inconveniences as opposed to more serious threats to a child’s wellbeing, but either can rarely be more serious requiring specialists management(orthopedist or podiatrist).  Of course, not all knee or heel pain is apophysitis.  So, if your child is experiencing these problems, give me a call and we can check it out together.

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