Doctors use a lot of tests, such as blood tests, x-rays, MRI scans, and quite a few others. Some of these tests carry well-known risks in doing them. For example, some people have serious allergic reactions to the contrast dye used in x-ray tests. When doctors order these tests on children we are making a judgment that the information the test will give us is useful enough, or important enough, to justify taking the risk. Most parents understand this notion.

What most parents don’t understand, though, is the risk the test will give misleading information. A blood test, something of little immediate risk to the child, becomes potentially quite risky if the result will confuse the situation, leading to further tests and procedures that might not be appropriate, or which carry further risks. In addition, every medical test has a built-in, inherent error rate; the test result may just be flat-out wrong — it’s a statistical possibility.

My point is that it is never a good idea to ask your doctor to do tests on your child just because you (or your doctor) are simply curious about the result. Any test needs to be clearly justified by a child’s specific situation.

If they’re not exactly killing us, they will eventually kill the economy. Everyone knows that health care costs are rising, generally much faster than the inflation rate. Many reasons are given for this, including such things as increased costs for medications, the cost of litigation (this one is influenced by whether or not you think there is a “malpractice crisis”), the aging of our population, and the built-in inefficiencies of the insurance industry. Whatever the reasons, though, a recent and telling study by the Congressional Budget Office lays out what most of us already knew: “The long-term fiscal balance of the United States will be determined primarily by the future rate of growth of health care costs . . . .”

We simply cannot sustain a rate of health care spending that is rising faster than the cost of anything else in the economy. In a way, we are victims of our own success in devising new medicines and treatments. But if nothing changes the CBO predicts that by the year 2050 health care would consume 20% of the national economy, a proportion which today is that of the entire federal budget. Clearly, something has to give. What will it be?

The only way I can see for this mess to get fixed is for everyone to agree there is a huge problem that is nobody’s entire fault — it is consumer demand that has largly driven the whole thing. We did it. So we have to dampen that demand in some way. How to do this? I fear ultimately it will come with draconian and inevitably soulless bureaucratic rules. But is doesn’t have to be that way. Each of us has the power to realize that when we demand a new medical service that hasn’t really been shown to work any better than cheaper ones, and when we insist on services shown to be of only marginal benefit, we are robbing from everyone else, especially our children who will be left with the bills. Equally important, when we demand expensive care for ailments that we largely caused in ourselves we are doing the same thing.

We are all a community. We need to solve this problem as a community.

 I would think by now, nearly 2008, that I wouldn’t have to write anything about the importance of child car seats. But I find I do, because I still see as I drive adults holding babies and toddlers over their shoulder, often while sitting in the front seat. This has been illegal in most places for many years, but it is still common and it is still stupid and dangerous. I also still see the results–several children each year come through the PICU who were unrestrained passengers in a car accident, and a few of them die.

Here are some statistics on car seats and motor vehicle accidents. (The most recent I could find come from 2003.) For that year nearly 59,000 children under the age of 5 were injured, 8% of them seriously, and about 1% died. This amounted to 471 children. Significantly, over one third of the children who died were unrestrained.

Most of us have been lectured to about these things, but I have found many parents have difficulty understanding notions of statistical risk. For example, one study showed 72% of parents were seriously afraid their child would be abducted by a stranger. That is a legitimate fear, but it is not very likely to happen; in fact, it is vanishingly unlikely. It is only one-fourth as likely as you getting struck by lightning.

My point is that parents should do what they can to reduce the chances of their child suffering harm: by all means tell your child about what to do when approached by strangers, but also please buckle them into a car seat, preferably in the back seat, when you drive anywhere with them, even a short distance.

You can find an excellent overview of all manner of car seats and how to use them here, at the American Academy of Pediatrics site.