AAP Recommendations for Treating Children After a Disaster

The American Academy of Pediatrics (AAP) has released a clinical report recommending a course of action in treating children who have experienced or witnessed a disaster. The full report, “Psychosocial Implications of Disaster or Terrorism on Children: A Guide for the Pediatrician,” was published in the September 2005 issue of Pediatrics and is available on the AAP Web site at http://pediatrics.aap-publications.org/cgi/content/full/116/3/787.

The report outlines several studies that were conducted after the Sept. 11, 2001, terrorist attacks in New York and Washington, D.C. Three months after the attacks, some children were deeply dependent on parents for emotional and psychological support. The studies found that parents’ moods and behaviors after traumatic events may add to a child’s fears. Parents also may not recognize symptoms of their child’s stress.

After a disaster, children may experience a range of symptoms, from mild stress reactions to more severe cases of post-traumatic stress disorder (PTSD). A child with adverse stress reactions lasting longer than one month after a disaster may be at higher risk of developing PTSD or violent behaviors later in life. Boys generally display higher rates of symptoms and require more time to recover than girls. Shy, fearful, or poorly supported children are at greater risk of developing negative mental reactions after trauma. Children with indirect exposure to a disaster on television also face the same risk as those witnessing it directly.

Physicians treating children after a traumatic event should be aware of patients who are at risk of adverse reactions or the development of symptoms of PTSD, and they should educate and counsel parents about the range of normal emotional and behavioral reactions of children to disaster. Physicians should help parents recognize the potential deleterious effects of indirect disaster exposure from news media and educate them about the importance of helping children understand information at a developmentally appropriate level.

Physicians should screen for anxiety in all patient encounters after a disaster. A simple question and expression of concern is an effective, brief intervention. For many children with supportive families, peers, and teachers, the reaction to traumatic experience resolves in a few months. A follow-up screening four to six months after the disaster would be appropriate to identify children with continuing symptoms who may need referral for additional services.

CDC Report on Vaccination Coverage in Children

The Centers for Disease Control and Prevention (CDC) reported increases from 2003 to 2004 in vaccination coverage among children 19 to 35 months of age for the combined vaccine series 4:3:1, 4:3:1:3:3, and 4:3:1:3:3:1 (see box) as well as for the recently implemented varicella and pneumococcal conjugate vaccines (National, State, and Urban Area Vaccination Coverage Among Children Aged 19–35 Months—United States, 2004 MMWR 2005;54:717–21). For the first time, coverage for the 4:3:1:3:3 series exceeded the Healthy People 2010 goal of 80 percent, although it varied substantially among states and urban areas, ranging from 68 percent in Nevada to 89 percent in Massachusetts.

The report states that coverage levels are notable given the supply shortage of several vaccines between 2001 and 2004. Recurrence of shortages is likely, therefore strategies for managing supply and continued monitoring are needed.

Breast Cancer Screening and Socioeconomic Status

The Centers for Disease Control and Prevention (CDC) has released a report on breast cancer screening for women in 35 major metropolitan areas in 2000 and 2002. Data for the report were collected from surveillance surveys and the 2000 U.S. Census. The findings were published in the October 7, 2005, edition of Morbidity and Morality Weekly Report and can be accessed online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5439a2.htm.

More than 250,000 women 18 years and older were interviewed to determine general demographic status and were asked if they had ever had a mammogram. Those who answered yes were asked the date of their last mammogram. Analyses for this report focused on women 40 years or older. Of these women, 9.6 percent had household incomes of less than $15,000 per year, and 23.7 percent had incomes of $15,000 to $34,999 per year. Overall, 78.5 percent reported having a mammogram during the two years preceding the study. Among women who reported annual household incomes of less than $15,000, 68.4 percent received a mammogram in the preceding two years; 75.3 percent of women with household incomes of $15,000 to $34,999 and 82.5 percent of women with household incomes of more than $50,000 had received a mammogram in the preceding two years. Women who did not complete high school or were never married and women who had no health insurance had lower mammography rates than those who were college graduates or had married, or who had health insurance.

The report shows that women with household incomes of less than $15,000 per year were less likely to have had a breast cancer screening test in the past two years than wealthier women, especially those living in affluent areas. Women with less education also were less likely to have had a mammogram.

The CDC suggests that women not eligible for Medicaid who do not have employer-sponsored health care may receive breast and cervical cancer screening through the CDC’s National Breast and Cervical Cancer Early Detection Program (http://www.cdc.gov/cancer/nbccedp).