Dr. Kevin Most: ACA News and some pediatric stuff

Dr. Kevin Most

The deadline for signing up the Affordable Care Act was this past Saturday night and there was quite a bit of confusion as well. The sign-up had been lagging in numbers substantially with somewhere between 20-25% less individuals signing up this year. If we look into why that is occurring a few things pop up. The enrollment period was cut dramatically from the historic 3 months to a mere 6 weeks, many states have extended the sign up period, however Illinois is not one of them. Another reason is the individual mandate was essentially struck down by eliminating the penalty fine for not having insurance, so individuals will no longer be forced to pay for insurance or pay a fine as of January 1, 2019. Many thought when it was struck down that it was immediate but in fact the fine goes away on January 1. This is thought to have some of the impact on the decrease sign up.

Another reason and one that is sad is the concept of “Public Charge” The Trump administration has implied that it will take into consideration “public charge” when looking at immigration status. The simple definition is that this is a term used to refer to a person who is considered primarily dependent on the government for subsistence. Individuals waiting for permanent residency have been able to access health care though the Affordable Care Act, with subsidies from the federal government based on their income just as citizens are. Immigrants who are found to likely become a public charge may be denied permanent resident status. This push by the Trump administration is causing many immigrants on the legal track for residency to decline ACA insurance this year. This will actually end up costing all of us more as individuals will again be postponing care or using the emergency rooms when in dire need at a very high cost.

What makes it even more confusing is that a federal judge on Friday declared the Affordable Care Act unconstitutional by saying that the individual mandate is unconstitutional and therefore the entire Act is invalid. This ruling will play out over the next year or two as it is argued by courts across the country.

The overall sad thing is that many who need insurance appear to not be covered this year and the impact will be felt by the individuals, hospitals and ultimately all of us

Pediatric News

Have we moved from a generation where the TV was a babysitter at times to a generation where computers and smartphones eliminate activity for many children?

Last week we discussed Christmas gifts and Justin brought up the “screen time” concern that many parents have. This same concern was raised on “60 Minutes” as some new studies have been published discussing the impact of screen time. As we approach Christmas many parents are probably considering video games and tablets as gifts for their children. These gifts will certainly impact screen time, so I thought we could discuss the recommendations and why they are made. The health impact of screen time is being studied and will continue to be studied as this is the first true generation with extended screen time. There are currently over 100 scientific reports that have looked at screen times and looking for emotional and behavioral differences based on screen time. More than 200 studies have been done to see if playing violent video games leads to aggressive behavior. Some have shown this others have not, raising the question do children who play violent games become aggressive, or are the aggressive children drawn to violent games. This is a very important point that needs further research.

I bet many of you have no idea of The American Academy of Pediatrics guidelines are when discussing screen time. The guidelines they propose are based on wellbeing, learning and development.

First let’s make sure we all have the same definition of what screen time is. It includes essentially everything in front of a TV, DVD, Computer, Tablet or smartphone. This is a wide spectrum of use as you think of all of the possible exposures. Now think of the exposure you may see in your own children, I think you may be shocked when you hear the recommendations.

Recommendations from the American Academy of Pediatrics

Children under the age of 18 months- the recommendation is to avoid the use of screen media with the exception of video chatting. Now I am sure many parents are rolling their eyes and thinking that is impossible. Many think this helps children develop, however this has not proven to be true.

Children aged 18-24 months- go ahead and introduce screen time to the child but only while you are with them as you explain what they are watching. Many parents use this as a respite or distraction tool to take a call or do a quick task.

Children ages 2-5- the recommendation is to limit screen time to 1 hour a day of high quality programs, again the recommendation is for the parent to be present during the viewing to answer questions and help them understand what they are seeing.

Children over the age of 6 – important to place consistent time limits and locations, like bedrooms, have media free times like dinner and driving, and to have continued communication about safety and treating others on line with respect. Researchers are concerned with children getting used to using the use of cell phones in the moving car as well as the ease of disrespect that can be completed easily on line.

Now many of you may be feeling one of many emotions or feelings, That is crazy, no one has that limiting placed on their child, children learn by using computers and smart phones, those are too conservative, these are just guidelines with no scientific basis.

The NIH is currently running a $300 million research study, that began in 2013 and is connected to 21 academic research centers. Interesting is that the study initially was studying the impact of drugs and alcohol on adolescent brains. It has been expanded to include screen time, brain trauma and many other environmental factors. In this study they have 4,500 children currently with the plan to extend this to 11,000 children. This is the first major study of this type. The plan is to study these children thru adolescences with annual MRI ( no radiation exposure like CT scan) They are looking to see if screen time has addictive properties, if it impacts cognitive skills including language and reasoning, and if it impacts brain development. They have reviewed how much time the children spend on screen time and the initial results are not too promising. Children who spend more than 2 hours on screen they score lower on aptitude tests and other cognitive skills. They also noted by CT scan that a portion of their brain did not develop as expected. Both of these results are not known if they will have a meaningful impact in the long run. This study will continue for at least another 10 years as it tracks the children and the impact on screen time.

Parents screen time

Now, Children are not alone in the scrutiny of screen time. A paper was co published out of the Universities of Michigan and Wisconsin, that said parents need to limit their screen time as well and that they need “off hours and off locations” as well. The paper highlighted that children learn many of their habits from their parents. The paper was written by behavioral pediatricians and showed that parents who were distracted or absorbed by their mobile devices had less child parent interactions and had more conflict with their children. This also led to more behavioral problems in the child.

For many of us growing up, our working parents were not interacting with work 24/7, answering emails and mobile phone calls did not exist. We actually had to talk to each other on car trips and in the evenings. Now it is not uncommon for a large percentage of the workforce to interact with their workplace each night and on the weekends, taking time away from their family or friends. This paper says adults should look and see what aspects of the smartphone stress them out the most and to only do those when no family members are around.

The paper also reminds parents that children mimic and copy their behavior. They suggest that mealtimes and bedtimes should be unplug and put away devices and make those family interaction times. If you are checking email or answering a text during dinner two things happen, one is children feel that they can as well and more importantly, children see that the phone is more important than they are. Children need this time for emotional, social and intellectual advancement. Parents are also urged to not photograph, document and post everything, share some moments without the photo and posting, this will demonstrate appropriate tech life balance.

Experts are concerned at how children will use screen-based technology in the future, and the impact it will make on the family dynamics.

 

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