Category: Blog

Can You Skip Your Newborn Baby’s Eye Ointment?

A lot of what happens in the delivery room and newborn nursery once your baby is born is routine.

Tragically, skipping some of this routine care, from a RhoGAM shot to the vitamin K shot and hepatitis B vaccine, is becoming standard for some anxious parents.

Some even want to skip getting the antibiotic ointment that is placed on their baby’s eyes that can help prevent ophthalmia neonatorum, which can lead to blindness.

Ophthalmia Neonatorum

Since we don’t usually think of pink eye (conjunctivitis) as a serious disease, it is likely hard to imagine that neonatal conjunctivitis (ophthalmia neonatorum) could lead to blindness. It does though – or did.

Ophthalmia neonatorum due to Gonococcus infection.
Ophthalmia neonatorum due to Gonococcus infection. (Photo by Murray McGavin CC BY 2.0)

The main cause was Neisseria gonorrhoeae, a sexually transmitted infection that could be passed to a baby when they were born. Similarly, Chlamydia trachomatis can cause ophthalmia neonatorum.

That ophthalmia neonatorum could be prevented was first discovered by a German gynecologist in 1881. Dr. Carl Siegmund Franz Credé instilled a drop of silver nitrate into a newborn’s eyes immediately after they were born and this greatly decreased the rates of infections in babies born in his hospital.

Today, erythromycin ophthalmic ointment and povidone-iodine have largely replaced the use of silver nitrate for preventing ophthalmia neonatorum, but it works on the same principle – killing any bacteria that might cause neonatal conjunctivitis, especially those that cause blindness.

Can You Skip Your Newborn Baby’s Eye Ointment?

Why skip a treatment that can prevent your baby from getting an infection that can lead to blindness?

Gonococcal ophthalmia neonatorum caused by a maternally transmitted gonococcal infection.
Gonococcal ophthalmia neonatorum caused by a maternally transmitted gonococcal infection. (Photo by CDC/ J. Pledger)

Since ophthalmia neonatorum is generally caused by gonorrhoea and chlamydia, most parents who think about skipping their baby’s eye ointment are likely fairly confident that they don’t have one of these sexually transmitted infections. And most of them will likely be right.

In fact, some countries, including Australia, the UK, Norway, Denmark, and Sweden, have stopped routine ophthalmia neonatorum prophylaxis. Some just treat those babies who are at high risk for infections, especially if they didn’t receive prenatal care or have a maternal history of STIs, etc.

In the United States, routine use of erythromycin 0.5% ophthalmic ointment within 24 hours of a baby’s birth for the prevention of ophthalmia neonatorum is still the standard of care. In fact, it is required by law in many states.

What are some of the issues to consider when thinking about skipping your baby’s eye ointment?

  • the incidence of gonorrhoea and chlamydia have been increasing in recent years and it is very possible to have these STDs without obvious symptoms
  • up to 30 to 50% of babies born to a mother with gonorrhoea or chlamydia will get neonatal conjunctivitis, even if they had a cesarean section
  • not all pregnant women are routinely tested for gonorrhoea and chlamydia
  • ophthalmia neonatorum caused by gonorrhoea or chlamydia can very quickly lead to permanent scarring and blindness
  • ophthalmia neonatorum caused by gonorrhoea or chlamydia is not as easy to treat as routine pink eye, often requiring hospitalization and systemic antibiotics
  • gonorrhoea and chlamydia aren’t the only bacteria that can cause severe neonatal conjunctivitis

Most importantly, if you are thinking about skipping your baby’s eye ointment, know that places that routinely stopped using eye ointment to prevent ophthalmia neonatorum often  saw an increased incidence of gonococcal ophthalmia, while rates remain very low in the United States.

“The annual figures for ON reported during the study period, under statutory health protection regulations, underestimated the actual occurrence of this disease by a very substantial amount.”

Dharmasena on Time trends in ophthalmia neonatorum and dacryocystitis of the newborn in England, 2000–2011: database study

And you are likely to get worried every time your baby has a little eye discharge or redness, just like parents who skip vaccines worry when their child has a fever or cough.

Since the eye ointment that is used is safe (erythromycin doesn’t cause the irritation that silver nitrate used to in the old days), why take the risk of an infection that can lead to blindness?

What to Know About Skipping Your Baby’s Eye Ointment

The use of erythromycin eye ointment after your baby is born can help to prevent a serious infection that can lead to blindness. Don’t skip it.

More on Skipping Your Baby’s Eye Ointment

New Report on Autism Rates

A new report on autism prevalence rates isn’t generating many headlines.

Why?

“There was not a statistically significant change in the prevalence of children ever diagnosed with autism spectrum disorder from 2014 to 2016.”

Zablotsky et al on Estimated Prevalence of Children With Diagnosed Developmental Disabilities in the United States, 2014–2016

While the rate seemed to increase on paper, from 2.24 to 2.76%, it was not a statistically significant change. If it had been a statistically significant change, then you could think autism rates really were increasing and the report would have made headlines beyond anti-vaccine websites.

“By trying to say that there is no significant increase, is the government hoping to reassure people that autism isn’t a significant problem? That the rising number of children with autism isn’t something that anyone has to worry about? Are they trying to avoid a panic?”

Dr. Bob Sears

As most people likely understand, the term significant is used in the report as a statistical term.

When something is found to be statistically significant, then you can be fairly confident that it wasn’t caused by chance alone.

“Significance is a statistical term that tells how sure you are that a difference or relationship exists.”

What does “statistical significance” really mean?

So by stating that “there was not a statistically significant change in the prevalence of children ever diagnosed with autism spectrum disorder,” they were not “trying to avoid a panic.” There is no conspiracy.

Unlike Dr. Bob and some others, they were simply trying to not mislead people into thinking that the change from 2.24 to 2.76% meant something that it did not.

Reports About Autism Rates

Another thing to keep in mind as you think about this report – there are multiple reports about autism prevalence rates that come out every few years.

The latest report uses National Health Interview Survey data that was collected by the National Center for Health Statistics.

Unlike the autism prevalence reports from the Autism and Developmental Disabilities Monitoring (ADDM) Network that we are used to, which reported a rate of 1 in 68 children in 2016, the NCHS reports:

  • National Health Interview Survey question about autism.
    The National Health Interview Survey question about autism.

    rely on parent reports during a telephone survey – one of the questions that they are asked is if a health professional has ever told them that their child has autism, but that diagnosis is not confirmed by looking at medical or school records

  • are prone to recall bias – parents might not accurately recall what doctors have told them in the past about their child
  • have questions that have changed over the years, for example, when PDD was added in 2014, it was thought that it might have confused some parents who didn’t know that a pervasive developmental disorder is different than a developmental disorder
  • look at lifetime prevalence

And not surprisingly, over the years, the NHIS has typically reported higher autism rates than the Autism and Developmental Disabilities Monitoring Network.

autism-rates
The NCHS autism prevalence rate reports have traditionally been higher than others.

So what does this new report on autism prevalence mean?

It means the same thing that all of the other recent reports have been saying, that autism prevalence rates seem to be unchanged.

What to Know About Autism Rates

After increasing for several years, autism rates seem to be unchanged, but that hasn’t kept anti-vaccine folks from trying to get parents to panic about changes in prevalence rates that are not statistically significant.

More on Autism Rates

Is There a Cure for Peanut Allergies?

Many parents likely got excited recently when they read about a possible cure for peanut allergies.

Peanut allergy could be cured with probiotics
Medical News Today

While these types of treatments are called cures by some people, what they do is desensitize you to peanuts, so that if you have a reaction, it is less severe. Some don’t have reactions anymore though. Probiotics were just part of the ‘cure’ though. They were paired with oral immunotherapy.

Is There a Cure for Peanut Allergies?

So is there really is a cure for peanut allergies?

I’m guessing it doesn’t matter if you call it a cure or a treatment if you have a child with a severe peanut allergy, you really just want to know if it is available for your child, right?

And again, there isn’t a simple answer.

Although it does seem like they are being used more and more, many of these treatments are still being tested, so they likely aren’t available everywhere, or in some cases, anywhere outside of a trial.

Among the treatments for peanut allergies, besides avoidance and treating anaphylactic reactions with epinephrine, you some day soon might be able to get your child with peanut allergies:

  • a wearable skin patch to provide epicutaneous immunotherapy (EPIT)  – in phase III studies
  • a pill to provide orally administered biologic immunotherapy  – in phase III studies
  • oral immunotherapy with Xolair (FASTX) – in phase II studies
  • a combination of probiotics with peanut oral immunotherapy (PPOIT)
  • sublingual immunotherapy (SLIT) – in phase III studies
  • a vaccine – in early phase I studies

How do these treatments work?

The patch is the easiest to explain. Kids simply apply a new patch that contains peanut protein on their skin each day.

Oral immunotherapy is similar, kids are exposed to peanut protein, but unlike the patch, the dose is steadily increased each day, until you read a maintenance dose, that you continue eating each day. Most of these treatments use some variation of the characterized oral desensitization immunotherapy (CODIT) method to control and maintain desensitization.

And these treatments are not just for peanuts. Similar studies are being done for eggs and milk. And theoretically, they can be done for anything that can trigger an IgE-mediated allergic reaction, from foods and medicines to environmental allergens.

The downside? In addition to side effects, in most cases, you have to continue eating the thing you are allergic to every day, otherwise your allergy might return.

So, Is There a Cure for Peanut Allergies?

While many of these treatments are promising, they are not ready for regular use in every doctor’s office.

“The aim of OIT is to administer a food allergen slowly, in small but steadily increasing doses, until the patient stops reacting to the food (termed becoming desensitized to the food). OIT studies have shown promising results, though adverse reactions are frequent and may cause significant side effects like abdominal pain, wheezing and/or diarrhea. Published data from placebo-controlled trials have shown that only 50 to 70 percent of patients attempting OIT complete desensitization, with the failures primarily due to side effects. Also, there currently are no standardized protocols or foods used in OIT and no FDA approved approach that could allow insurance to reimburse for this therapy. Thus, there are challenges with the current practice of OIT.”

FARE Statement on Oral Immunotherapy for Food Allergies

That doesn’t mean that you can’t get some of these treatments right now or overcome those challenges.

Avoiding peanuts is not always as easy as you think... Peanuts under my seat on a plane.
Avoiding peanuts is not always as easy as you think… Peanuts under my seat on a plane. Photo by Vincent Iannelli, MD

Just keep in mind that “An allergist doing OIT for patients in a private practice develops his/her own individualized protocols and uses his/her unique food preparation.”

If your child’s food allergy has led to severe stress and anxiety for your family, that might not matter though. You probably don’t want to wait anymore if there is a chance at reducing your child’s chance of having a severe, life-threatening allergic reaction.

Still, find a pediatric allergist who has a lot of experience doing private practice OIT.

On the other hand, if you are fine refilling your child’s epi-pens every year and working hard to avoid peanuts, then maybe wait until the jury comes in and we get an official recommendation and more standardized treatments become more widely available.

What Else Should You Be Doing About Food Allergies?

If you don’t do private practice OIT, then in addition to strictly avoiding the things to which your child is allergic and making sure that an epi-pen is always readily available, the latest guidelines recommend that your child have:

  • annual testing if they have a milk, egg, soy, or wheat allergy
  • testing every two to three years if they have a peanut, tree nut, fish, or shellfish allergy

Why retest?

Kids do sometimes outgrow their allergies, especially if the allergy isn’t to peanuts or tree nuts. And even for peanuts, about 20% of kids have a chance of outgrowing their allergy.

Also remember that it is now recommended that infants at high risk for peanut allergies, especially those with eczema, have an early introduction of peanut proteins, sometimes as early as four months of age.

Hopefully that will help decrease the number of kids who need these kinds of treatments in the future.

What to Know About Treating Peanut Allergies

Oral immunotherapy and some other treatments are providing new options to help kids with severe food allergies avoid life-threatening reactions.

More About Treating Peanut Allergies

Misunderstanding the Affordable Care Act and Understanding Why It Should Be Saved

If the Affordable Care Act (Obamacare) gets repealed, it likely won’t be because folks understand what it does.

The American Academy of Pediatrics is opposed to plans to repeal the ACA and wants to KeepKidsCovered.
The American Academy of Pediatrics is opposed to plans to repeal the Affordable Care Act and is working hard to #KeepKidsCovered.

It will be because many people don’t realize that they are benefiting from Obamacare or even what it really does.

Obamacare Under Attack

The Affordable Care Act has been under attack almost from the day it was enacted.

Since the original Repealing the Job-Killing Health Care Law Act, and through dozens of others, we have most recently had the:

  • Better Care Reconciliation Act
  • Obamacare Repeal and Reconciliation Act
  • Health Care Freedom Act (“Skinny” repeal)

They all failed.

The latest attempt to repeal Obamacare is the Graham-Cassidy-Heller-Johnson Bill.

Will this bill pass?

As a pediatrician, I am fearful for my patients and the uncertain future they would face under Senators Lindsey Graham (R-S.C.) and Bill Cassidy’s (R-La.) health care proposal, currently set for a vote next week in the U.S. Senate. As president of the American Academy of Pediatrics, I must speak out against this dangerous, ill-conceived policy on behalf of our 66,000 pediatrician, pediatric surgical specialist and pediatric medical subspecialist members, and stop it from advancing…

The American Academy of Pediatrics urges the Senate to oppose the Graham-Cassidy proposal, and instead turn to bipartisan solutions that are crafted in the best interest of children and families, like the Children’s Health Insurance Program and Maternal, Infant and Early Childhood Home Visiting program, which both expire next week. Pediatricians will continue to focus on the children we care for as this process unfolds, and we will not stop speaking up on their behalf until we see legislation that puts them first.

Fernando Stein, MD, FAAP, President, American Academy of Pediatrics on the AAP Statement Opposing Graham-Cassidy Health Care Proposal

Like the other bills, the Graham-Cassidy-Heller-Johnson Bill will fail if any of these organizations that have come out in opposition have anything to say and do about it:

  • American Academy of Pediatrics (AAP)
  • American Medical Association (AMA)
  • American Nurses Association
  • American Congress of Obstetricians and Gynecologists (ACOG)
  • American Academy of Family Physicians (AAFP)
  • American Osteopathic Association (AOA)
  • American Public Health Association
  • National Association of Pediatric Nurse Practitioners
  • First Focus Campaign for Children
  • Children’s Defense Fund
  • Children’s Dental Health Project
  • Family Voices
  • American Psychiatric Association
  • AARP
  • National Council for Behavioral Health
  • American Hospital Association
  • ALS Association
  • American Cancer Society Cancer Action Network
  • American Diabetes Association
  • American Heart Association
  • American Lung Association
  • Arthritis Foundation
  • Cystic Fibrosis Foundation
  • Family Voices
  • JDRF
  • Lutheran Services in America
  • March of Dimes
  • National Health Council
  • National Multiple Sclerosis Society
  • National Organization for Rare Diseases
  • Volunteers of America
  • WomenHeart

How can they pass a health law that every major health organization opposes?

“This bill contains proposals we have seen in previous bills, and we already know they would be bad for people with CF – and some cases, go even further. Graham-Cassidy would allow states to get rid of certain pre-existing condition protections, open the door to annual and lifetime coverage caps and high risk pools, and make massive cuts to Medicaid.”

Cystic Fibosis Foundation

In addition to repealing parts of the Affordable Care Act (ACA), Graham-Cassidy:

  • makes massive cuts to Medicaid
  • turns Medicaid into a block grant and caps its funding
  • ends Medicaid expansion
  • eliminates ACA’s marketplace subsidies

Graham-Cassidy should not be allowed to pass.

Add your voice to the opposition if you agree. Contact your Representative and Senators to let them know that you oppose the Graham-Cassidy ACA repeal bill.

Understanding the ACA

Most people understand that the ACA allowed many uninsured people to finally get insurance. Either with the help of tax credits, simply because the plans were available, or through the expansion of Medicaid, about 20 million have insurance because of the ACA.

What many people don’t realize is that they likely benefited from the ACA, even if they aren’t one of these 20 million people.

Some of the ACA benefits for everyone with any kind of insurance included:

  • no refusal for coverage because you have a pre-existing condition – which could include things like asthma, ADHD, anxiety, and depression or a cancer that is in remission
  • coverage for young adults so they could stay on their parent’s insurance plan until they are 26 years old, even if they are in school, working, or married
  • the elimination of annual and lifetime limits or caps – which some kids with complex health problems could reach in a single year
  • no co-pays for preventative care visits, from well-child visits and vaccines to mammograms and colonoscopies and well adult visits for men and women
  • no co-pays for breastfeeding support, supplies, and counseling
  • coverage for maternity services
  • coverage for mental health and substance abuse services
  • insurance plans can’t drop you if you get sick

Most people like those benefits.

Personally, I no longer see parents who worry about my diagnosing their child with asthma or anxiety because of how it “will look” on their insurance. And we don’t have to worry that a diagnosis of anxiety or depression won’t be covered because they have insurance that doesn’t include mental health benefits.

And, even though the Vaccines for Children program was available, it is nice knowing that insurance covers their vaccines that can protect them from life-threatening vaccine-preventable diseases.

Misunderstanding the ACA

Not realizing all of these benefits is only one way that folks misunderstand the ACA.

Are premiums under Obamacare soaring?

Actually no. Insurance premiums have gone up at slower rates for all of us than they did before Obamacare took effect!

“We have a national law that will continue to work overall, but which has some problem spots. That frames the real choice here. It is not, as Trump, McConnell, and Ryan would cynically lead the American people to believe, between repealing the ACA or coping with impending disaster. Rather, it is between repealing the law and repairing it.”

Scot Lehigh on Hard truths about Obamacare

Do some people have fewer options as some major insurers drop out of the ACA Marketplaces? Sure. But that’s still better than the zero options they likely had before the ACA when they were uninsured.

What about the idea that Obamacare is failing overall? It’s not.

What to Know About Misunderstanding the ACA

Obamacare is not failing and has helped millions of people get insurance coverage. All of the plans to repeal and replace it have been huge steps backwards that have been opposed by every major health organization.

More Information About Misunderstanding the ACA

What Is the American College of Pediatricians?

Every time you hear about or read something and quickly think to yourself, “did the American Academy of Pediatrics really say that?” – it’s almost certainly from the American College of Pediatricians.

Tucker Carlson turns to the American College of Pediatricians when he wants to take sides against transgender kids and their parents.
Tucker Carlson turns to the American College of Pediatricians when he wants to take sides against transgender kids and their parents.

The names sound alike, perhaps intentionally, but the two groups couldn’t be more different.

Who are they?

The American College of Pediatricians is basically the Bizarro World version of the American Academy of Pediatrics.

The American College of Pediatricians vs American Academy of Pediatrics

Like the Association of American Physicians and Surgeons, the American College of Pediatricians (ACPeds) pushes and promotes “misleading and incorrect” recommendations based on the ideology of their members, not using science and evidenced based medicine.

“…ACPeds was born from an ideological split within a profession. It was founded in 2002 as a protest against the much larger American Academy of Pediatrics’ support for LGBT adoption rights — and that opposition remains central to the group’s identity…

But thanks to its deceptive name — which makes it sound as if it is the mainstream professional organization for pediatricians — ACPeds often serves as a supposedly scientific source for groups pushing utter falsehoods about LGBT people.”

Southern Poverty Law Center on how the American College of Pediatricians Defames Gays and Lesbians in the Name of Protecting Children

That’s why most of the press releases and position statements from the ACPeds are against (while the AAP supports):

Michelle A. Cretella, MD, FCP (Fellow of the College of Pediatricians), the President of the American College of Pediatricians, has even praised the book Preventing Homosexuality, calling it “an invaluable resource for parents.” She is also on the Board of Directors of the National Association for Research and Therapy of Homosexuality (NARTH), a group that supports reparative or conversion therapy for homosexuals.

The American College of Pediatricians goes so far as suggesting adding a ‘P’ to LGBT acronym. No, the ‘P’  wouldn’t stand for pansexual in their world – it would stand for pedophile.

“In one sense, it could be argued that the LGBT movement is only tangentially associated with pedophilia. I see that argument, but the pushers of the movement, the activists, I think have pedophilia intrinsically woven into their agenda. It is they who need to be spoken to and against.”

American College of Pediatricians Blog on “P” for Pedophile

The American College of Pediatricians (ACPeds) is considered a fringe group and should never be confused with the mainstream American Academy of Pediatrics (AAP):

ACPeds AAP
200 to 500 members in just 47 states 66,000 members in 50 states, Puerto Rico, Washington D.C., and Canada
founded in 2002 founded in 1930
makes claims against vaccines supports vaccinating and protecting kids
supports corporal punishment by parents opposes spanking
designated as a hate group not a hate group
“The American College of Pediatricians promotes a society where all children, from the moment of their conception, are valued unselfishly. We encourage mothers, fathers and families to advance the needs of their children above their own. We expect societal forces to support the two-parent, father-mother family unit and provide for children role models of ethical character and responsible behavior.” “The American Acade​my of Pediatrics is dedicated to the principle of a meaningful and healthy life for every child. As an organization of physicians who care for infants, ​​children, adolescents, and young adults, the Aca​demy seeks to promote this goal by encouraging ​and assisting its members in their efforts to meet the overall health needs of children and youth; by providing support and counsel to others concerned with the well-being of children, their growth and development; and by serving as an advocate for children and their families within the community at large.”

Yes, the American College of Pediatricians is actually considered an active hate group by the Southern Poverty Law Center!

What to Know About the American College of Pediatricians

A fringe group of pediatricians, the American College of Pediatricians promotes misleading information based on the ideology of their very small group of members.

More About the American College of Pediatricians

 

 

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Viewing the Solar Eclipse – Hype or Hazard

A total solar eclipse is a big deal, although it seems like it might be a bigger deal for some people than it is for others.

What kind of eclipse will you be able to see on August 21st? Map courtesy of NASA.
What kind of eclipse will you be able to see on August 21st? Map courtesy of NASA.

It does start to seem like a bigger deal the more you learn about it…

Solar Eclipse HYPE

Still, there is a lot of hype surrounding the upcoming solar eclipse in the United States.

“Observing a total solar eclipse is a life-changing event. It challenges everything you conceive of as normal.”

Sean Lindsay on the Eclipse hype

Do you buy it?

  • will looking at the eclipse make you go blind?
  • will seeing the eclipse change your life?
  • will you regret missing the eclipse for the rest of your life?

While viewing the eclipse won’t make you go blind, at least not instantaneously, what about all of the hype about how important an event the eclipse is to view? That part has to be true, right?

“A partial eclipse is interesting but forgettable, while a total eclipse is a memorable, life-changing event which burns itself into memory – and never fades. And so we, who have seen this sight, ask you to join us on this momentous day, and do everything you possibly can to see it with us. But you must remember that “close” is not close enough; in order to see the eclipse in all its glory, you simply must…”

“Close” is NOT close enough!

It is for some people. And you might not know if you or your kids are that type of person unless you go and see the eclipse! In totality!

Solar Eclipse HAZARD

  • seeing the eclipse without protection will damage your eyes

We all know that you shouldn’t look directly at the sun or your eyes will get damaged.

And in most cases, you can’t.

It hurts to look at the sun. You’re pupils will constrict. You will blink a lot. And you will very quickly turn away.

At least in normal circumstances.

A solar eclipse is not a normal circumstance.

Since most of the sun is covered, you could likely stare at it (but definitely shouldn’t) and get a good long look at the eclipse. Unfortunately, the part that isn’t covered will be painlessly damaging your eyes, leading to burns on your retina and solar retinopathy.

But isn’t all of the sun covered in a total solar eclipse?

“During the very brief time the sun is in total solar eclipse it is safe to look at it, but do so with caution. Even during the total solar eclipse, the total eclipse may last only a short period of time, and if you are looking towards the sun as the moon moves away from blocking the sun, you might get a solar burn on your retina which can cause permanent damage to your eyes.”

Prevent Blindness America

Yes, but only for a very short time and only if you are in the path of totality.

During totality, it is safe to take your eclipse glasses off and look at the eclipse, being aware that totality may last only a minute or two.

This diamond ring means that the eclipse is not at totality yet and you still need eye protection to look at the sun.
This diamond ring means that the eclipse is not at totality yet and you still need eye protection to look at the sun. Photo courtesy of NASA.

Again, you must be very sure that you are inside the path of totality for a chance at looking at the eclipse without protection – a 70-mile wide band from central Oregon through South Carolina.

If you are not in this relatively narrow band, you will still be able to see a partial solar eclipse, but at no time will it be safe to view the eclipse without protection.

Are you going to be able to see a total or partial eclipse on August 21st?
Are you going to be able to see a total or partial eclipse on August 21st?

Remember that even if you live in or have traveled to a spot inside the path of totality, the total eclipse itself will only last a few minutes.

The whole eclipse will last much longer though.

From the start of the eclipse, to maximum eclipse, to the end of the eclipse, you might be looking at a three hour event. That’s a lot of time to be at risk of looking at the sun outside of totality and getting eye damage if you aren’t wearing protection.

Safely Viewing the Solar Eclipse

What kind of protection do you need to safely view a solar eclipse.

Fortunately, you have a lot of options.

This solar eclipse viewing protection can include using:

  • solar filters, including ISO 12312-2 compliant eclipse glasses that have been sold online in packs of 5 or 10 (but including some that have been recalled), handheld solar viewers,  and full aperature solar filters for cameras and telescopes
  • a pin-hole viewer that you can easily make yourself with something as common as a cereal box
  • a 2D or 3D printable pinhole projector
  • a solar viewing projector using binoculars or a telescope (not looking through the telescope itself though, unless it had a proper solar filter!)
  • No. 13 or 14 welder’s glasses

But unless you are building a pin-hole viewer or are going to an official eclipse viewing event, be sure your protection is really going to protect your child’s eyes. Are the eclipse glasses you ordered fake, recalled, scratched, or damaged? Then don’t use them.

And make sure younger children are well supervised during the entire eclipse, so that they don’t look at the eclipse at any time that you are outside the time that you are in totality.

Some people will have a better chance of viewing a total solar eclipse in 2024.
Some people will have a better chance of viewing a total solar eclipse in 2024.

What if they miss it?

They won’t have to wait too long for the next total solar eclipse. Another one is headed our way in 2024.

What to Know About Safely Viewing the Solar Eclipse

I don’t know if it will change your child’s life, but there is no good reason to let them miss this total solar eclipse (or partial eclipse if you aren’t in the path of totality), as long as you take some very simple steps to make sure they view it safely.

More About Safely Viewing the Solar Eclipse

Don’t Skip Your RhoGAM Shot

I’m kind of shocked that I am having to write about warning folks to not skip their RhoGAM shot.

“Prophylactic anti-D immune globulin should be offered to unsensitized Rh D-negative women at 28 weeks of gestation. Following birth, if the infant is confirmed to be Rh D positive, all Rh D-negative women who are not known to be sensitized should receive anti-D immune globulin within 72 hours of delivery.”

ACOG on Prevention of Rh D Alloimmunization

Unfortunately, like with the vitamin K shot, in addition to trying to scare new moms away from getting vaccines, they also tell them to skip their RhoGAM shot.

What is RhoGAM?

RhoGAM (RhIg) or anti-D immune globulin is not a vaccine.

A RhoGAM shot can help prevent hemolytic disease of the newborn and fetus.
A RhoGAM shot can help prevent hemolytic disease of the fetus and newborn.

It is a prescription immune globulin shot that is given to some pregnant and post-partum women to prevent Rh (Rhesus) immunization, which can lead to hemolytic disease of the fetus and newborn if you get pregnant again.

RhoGAM was approved by the FDA in 1968.

RhoGAM Questions and Answers

If you have been educated about RhoGAM on the Internet and are thinking about skipping your RhoGAM shot, it might be time for a little more research:

  1. What is hemolytic disease of the fetus and newborn (HDFN)? It is not to be confused with vitamin K deficiency bleeding, which can be prevented with a vitamin K shot. Also known as erythroblastosis fetalis, HDFN occurs when a mother develops antibodies against her baby’s own red blood cells and destroys them, leading to anemia, jaundice, and edema. In severe cases, this can be life-threatening and the baby can develop hydrops fetalis.
  2. Why would a mom develop these antibodies against her own baby’s blood in the first place? Since a baby’s blood type is determined by both their mom and dad’s blood type, it is easy to see how it might be different than moms. This usually isn’t a problem, after all, a mother’s immune system doesn’t usually attack any other cells of the placenta or her baby (immune tolerance of pregnancy) that might be “foreign.” Unfortunately, it is not uncommon for a baby’s blood and “foreign” red blood cells to mix with mom’s blood, which could trigger antibodies to form.
  3. How does a baby’s blood mix with mom’s blood? Doctor’s have long known that while mixing is not common during a women’s pregnancy, it can commonly occur when she gives birth, explaining how Rh disease used to kill 10,000 babies each year in the United States. It doesn’t take trauma, a procedure (amniocentesis or chorionic villus sampling), or a difficult delivery for a baby’s blood cells to leak into a mother’s bloodstream. It can just happen. Mixing can also happen after a miscarriage, an ectopic pregnancy, or an induced abortion. Simply trying to turn a baby from the breech to a head-down position before delivery (external cephalic version procedure) leads to fetal-maternal hemorrhage in 2 to 6% of cases.
  4. Who needs to get a RhoGAM shot? It is hopefully clear already that not everyone is at risk to develop Rh immunization and so not everyone needs RhoGAM. Some folks can safely skip their RhoGAM shot, but only because it would never have been recommended for them in the first place. You only need RhoGAM if your baby’s blood type might be different than yours, specifically the Rh D antigen of the blood  and if you (mom) are Rh D negative (Rh-negative). Why don’t we worry about the ABO part? While an ABO incompatibility can also cause hemolytic disease of the newborn, it is usually much more minor. Why don’t we worry if you are Rh-positive and the baby is Rh-negative? If your baby is Rh-negative, then he or she wouldn’t have any Rh antigens on their red blood cells to make antibodies against.
  5. What is the chance your baby will be Rh-positive? It depends. And is actually more complicated than people think. If dad is Rh-positive, he can be either +/- or +/+, because there are two alleles for the Rh gene and Rh-positive is dominant. So if mom is Rh-negative (she can only be -/-), then their baby could either be +/- or -/-, so has at least a 50% chance of being Rh-positive. On the other hand, if dad is definitely +/+, then there will be a 100% chance that the baby will be Rh-positive. If you are confused now, then you don’t want to think about how two Rh-positive parents can have a Rh-negative baby!
  6. When will I get my RhoGAM shot? The current guidelines are to get a RhoGAM shot at around the 28th week of pregnancy to prevent Rh sensitization for the rest of the pregnancy; within 72 hours after the delivery of an Rh-positive infant; after a miscarriage, abortion, or ectopic pregnancy; or after amniocentesis or chorionic villus sampling.
  7. Can I skip my RhoGAM shot? You can skip your RhoGAM shot if you are already Rh sensitized (because it’s too late and RhoGAM won’t help for any future pregnancies) or if you are Rh-positive.  You will know if you are already Rh sensitized because a blood test is done to check for Rh antibodies. When paternity is certain (you know who the father is), and the father is Rh-negative, you can also skip the shot you would get at 28 weeks.  You can also skip your RhoGAM shot if your baby is Rh-negative.
  8. How do you know if you are already Rh sensitized? Moms who are Rh-negative get an antibody screen to see if they have Rh antibodies when they are 28 to 29 weeks pregnant.
  9. Why do some women seem to safely skip their RhoGAM shot and have a healthy baby? Like with skipping a vitamin K shot or with skipping or delaying vaccines, the risk of a baby developing hemolytic disease of the fetus and newborn isn’t 100%, so these parents who skipped their RhoGAM shot gambled and got lucky their baby wasn’t harmed.
  10. But don’t they do it differently in other countries? Yes. In the UK, they routinely give all Rh-negative mothers either one dose of RhoGAM at 28-30 weeks or two doses, one at 28 weeks and another at 34 weeks. New mums will also get a shot after their baby is born if their baby is Rh-positive.

Don’t skip your RhoGAM shot if it has been recommended. If you do, you will have a 13-16% chance of becoming Rh sensitized, which can affect your next pregnancy.

RhoGAM Myths

But your OB/Gyn doctor gives you RhoGAM, so why is a pediatrician writing about it?

Because getting RhoGAM prevents hemolytic disease of the fetus and newborn. If you ever see, or hopefully just read about a baby with hydrops fetalis, you will understand why pediatricians don’t want you to skip anything just because of something you read on the Internet, especially myths like:

  • RhoGAM is a vaccine – not true. RhoGAM is made of antibodies. And while it is a blood product, it is extensively screened and tested for infections. Of course, you shouldn’t skip any of your pregnancy vaccines either, like your flu or Tdap vaccines.
  • RhoGAM contains mercury – not true. RhoGAM is thimerosal free.
  • You only need RhoGAM if you have been in a car accident – not true, at all. Again, even in a normal pregnancy, with a “gentle birth,” there can be mixing of blood. And it doesn’t take a lot of blood mixing. As little as 0.1ml of blood (keep in mind that a teaspoon is 5ml) can trigger Rh sensitization.
  • hemolytic disease of the fetus and newborn is easily treatable – not true. While it might be true for more minor ABO blood incompatibilities, it is not true for Rh disease. If a baby develops hydrops fetalis, they might need intrauterine fetal blood transfusions and an early delivery. After they are born, babies with hydrops fetalis will likely need blood transfusions (because of severe anemia), exchange transfusions (because of extreme levels of jaundice), medicines to manage heart failure, phototherapy, and will likely be on a ventilator to help them breath. And even in a modern NICU, babies with hydrops fetalis still die.
  • everyone is offered a RhoGAM shot as part of a Big Pharma profit ploy – not true. RhoGAM is only given to moms who are Rh-negative, and since 85% of people are Rh-positive, most are never offered RhoGAM.
  • you can just wait to see if you want to get the shot later – not true. If you are Rh-negative and skip the pregnancy dose, waiting until your baby is born to see if they are Rh-positive, you may have already become sensitized. Mixing of blood occurs during pregnancy in at least 12% of cases and that is not just with car accidents, procedures, or trauma. Before RhoGAM started to be used during pregnancy, instead of just after, almost 2% of moms still became sensitized. Although that might seem like a small number, when you consider that almost 4 million babies are born in the United States each year, it ends up being a lot of babies at risk for HDFN if moms start skipping their RhoGAM shots.
  • you can just skip the shot if you don’t want any more kids – not true. Want if you change your mind and decide you do want more kids or have a “happy accident.”
  • there are natural ways to prevent Rh-sensitization – not true.
  • Rhogam causes serious side effects – not true. Rhogam is safe and doesn’t cause autism or any of the other serious side effects that you might see listed on sites trying to scare you away from getting your shot.
  • “First time mothers do not need it. A dose at 28 weeks is unnecessary unless a test shows sensitization has already occurred.” – ridiculously untrue, but I included it to show what kind of advice you will find on some websites. First time mothers definitely could need it, if they are Rh-negative, so that they don’t become sensitized, and if they are already sensitized, a dose isn’t going to help them!

Again, don’t skip your RhoGAM shot.

What To Know About Getting a RhoGAM Shot

There is no reason to skip your RhoGAM shot if it has been recommended for you during or after your pregnancy.

More About Deciding To Get A RhoGAM Shot