WEDNESDAY, Oct. 8 (HealthDay News) -- For American children, the state they live in and their family's income and education may help determine how healthy they are, a new survey shows.

Among children aged 17 and younger, 16 percent are in less than optimal health, according to the state-by-state survey from the nonprofit Robert Wood Johnson Foundation.

But that rate ranged widely by state: from 22.8 percent of children in Texas to only 6.9 percent of children in Vermont.

"Child health is a foundation for his or hers health throughout life," Dr. Paula Braveman, director of the Center on Social Disparities in Health at the University of California, San Francisco, and co-author of the report, said during a Tuesday teleconference. "So, the health of our children is not only an important concern in itself, it's a very important indicator of the health of the nation."

The report, America's Health Starts With Healthy Children: How Do States Compare?, provides new evidence that children in the United States are not as healthy as they could be, Braveman said.

"This report shows how much healthier kids in each state could be if we narrow the gap between the children of the wealthiest, most educated families and everyone else," she said.

"The report spotlights poverty as a cause of ill health in kids, and downplays the role of health insurance," said Steffie Woolhandler, an associate professor of medicine at Harvard Medical School and co-founder of Physicians For A National Health Program. "Poverty, however, is a lack of access to resources, and one resource that many poor children cannot access is health care. Lack of adequate health insurance forces parents to go without care for themselves and their kids. While figuring out how to end poverty is complex, figuring out how to achieve universal access to health care is simple -- nonprofit national health insurance."

Children's health improves along with increasing levels of family education and income, Braveman noted. "Children in poor and less-educated families generally have the worst health, but even children in middle-class families fare worse than those at the top," she said.

Sue Egerter, co-director of the University of California, San Francisco, Center on Social Disparities in Health, and another of the report's authors, noted that in the United States a full third of children in the poorest households are in less than very good health, compared with 7 percent of children in more affluent households.

"These children are not simply suffering from earaches, these are kids with much higher rates of chronic medical conditions including asthma, respiratory allergies and learning disabilities," Egerter said during the teleconference. "These are kids who, quite simply, have more health problems than most other kids."

The same health disparities exist among middle-class children, Egerter said. "Middle-class kids are nearly one and a half times as likely as children in higher income families to be in less than very good health," she said.

Two stark examples of the disparity in children's health are found in the states of Texas and New Hampshire.

Texas has the highest rate of children in "less than optimal health." Among poor Texan families, 44 percent of these children fall into that category, compared with only 6.7 percent of children in higher-income families. This is the largest income gap in children's health of all the states.

In contrast, only 13 percent of low-income children in New Hampshire have less than optimal health, compared with 6.4 percent of children in higher-income families. This is the smallest income gap of all states, Egerter said.

Even children in middle-income families can experience shortfalls in health compared with children in higher-income families, according to the report. These differences in health are also seen across racial and ethnic groups.

After New Hampshire, the states with the smallest gaps in health between children from high- or low-income families are Virginia, Minnesota, North Dakota and Wyoming. Those with the widest gaps include Texas, Arizona, Nevada, Louisiana, Washington, D.C., and Mississippi, according to the report.

Another factor influencing children's health: a mother's education. Across the country, babies born to mothers who have at least 16 years (i.e., a college degree) of education are less likely to die before reaching their first birthday than babies born to mothers who have not finished high school.

For example, in South Carolina, infant mortality among mothers who have not graduated high school reaches 11.6 deaths per 1,000, compared with 5.3 deaths per thousand among mothers who have had at least 16 years of education. This is one of the largest gaps in infant mortality based on years of school, according to the report.

Despite this, infant mortality rates in almost every state exceed what ideally could be achieved -- a national benchmark rate of only 3.2 deaths per 1,000, Egerter said.

Other report highlights:

• Children in poor families in most states are six times more likely to be in less than optimal health, compared with higher income families.
• Children in middle-income families are twice as likely, in some states, to be in less than optimal health than children in higher income families.
• Infant mortality is 40 percent higher among mothers with 13 to 15 years of schooling, compared with mothers with at least 16 years of school.
• Children in homes without a high school graduate are more than four as times likely to be in less than optimal health as children in a home with a high school graduate, and four times as likely to be in suboptimal health as a child in a home where someone has been to college.

Improving children's health across the United States means not only improving access to the health care, but improving the conditions in which many children are raised, Egerter said.

"We need to change the conversation about health in this country," Egerter said. "We need solutions beyond the medical care system to improve the health of children in this country. Children need the right physical and social conditions to help them be healthy kids who develop into healthy adults. Focusing on health care and coverage is important, but we need to recognize that there is more to health than health care," she said.

Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine, agreed that household income is key.

"A lot of detailed information in this compelling report distills down to a simple and rather common sense message: the fewer social and economic advantages enjoyed by a household, the worse the health of the children being raised there," Katz said. "Babies born to households deficient in education and income are more likely to die in infancy and less likely to experience optimal health," he added.

This report is a tale of trickle-down disparities, Katz said. "Disadvantaged parents raise children disadvantaged from the start with regard to both health and survival," he said.

The problem of disparities is clear, but the solution is much less so, Katz said.

"Can we get all children born in the U.S. to experience a uniform opportunity for survival and optimal health? Perhaps, but only with real dedication to a mission that will be neither quickly nor easily accomplished," he said.

More information

To see the full report, visit theRobert Wood Johnson Foundation  .

TUESDAY, Oct. 7 (HealthDay News) -- Saying they were acting "out of an abundance of caution," the makers of over-the-counter cough and cold medicines said Tuesday that the medicines should not be given to children younger than 4 years old.

In addition, the companies announced that they would be using child-resistant packaging and new measuring devices for the products, Dr. Janet Woodcock, director of the Center for Drug Evaluation and Research at the U.S. Food and Drug Administration, told reporters at a Tuesday afternoon teleconference.

"This is another step in the reassessment of children's over-the-counter cough and cold medications that has been going on," Woodcock said. "We at FDA support these voluntary actions at CHPA [Consumer Healthcare Products Association]. We are continuing to assess the safety and efficacy of these products."

The FDA has also taken steps to revise the OTC monograph -- written in the 1970s -- for these medicines; FDA monographs help determine how a drug will be marketed. The new monograph will take into account new research, some of which has yet to be completed.

The FDA has had discussions with the OTC [over-the-counter] industry about changing labels, Woodcock said, and, recognizing that the rule-making process would take several years at best, supported this voluntary action.

There will be a transition period while the new labels replace existing labels on products on pharmacy shelves. So parents and caregivers should adhere to the actual labels on the products they have and should consult with their doctor or pharmacist if they have any questions, Woodcock said.

Use of the over-the-counter medicines has been controversial, with pediatricians criticizing the marketing of the remedies for children under 6, citing reports of safety problems -- even deaths -- and a lack of evidence that they work.

"The number-one cause [of problems] is accidental ingestion, so the number-one advice is keep the medication out of the reach of children," Woodcock said. "Number two is follow directions carefully and don't give multiple medications, which may have the same ingredient."

In announcing the new industry guidelines, Linda Suydam, president of the CHPA, said they "reflect industry's overall commitment to the continued safe and appropriate use of children's oral OTC cough and cold medicines," the Associated Press reported.

Companies were voluntarily making the change "out of an abundance of caution," she said. The association represents leading manufacturers and distributors of nonprescription, over-the-counter medicines and nutritional supplements.

The new instructions will appear on products distributed for the coming cold season, Suydam said. Companies will also add a warning to their product labels saying parents should not give young children allergy-relieving antihistamines to make them sleepy, the AP said.

Pediatricians welcomed Tuesday's announcement by the industry, the news service said.

"It's a huge step forward," said Dr. Joshua Sharfstein, Baltimore's health commissioner and a leader in the push to stop marketing the medicines for young children. "There is no evidence that these products work in kids, and there is definitely evidence of serious side effects."

Earlier this month, the FDA held a public hearing on the use of OTC cold medicines for children between 2 and 6 years old. But the agency put off a decision on whether they were safe, saying more data was needed.

Dr. John Jenkins, who heads the FDA's Office of New Drugs, said at the time that agency officials were also concerned that an immediate ban, supported by leading pediatricians' groups, might cause parents to give adult medicines to their children.

"We do not want to do something that we think will have a positive impact, only to have an unintended negative," Jenkins said at the hearing, the AP reported. "That could be an even worse situation."

Back in January, the FDA issued an updated health advisory that cough and cold preparations not be used to treat children under the age of 2 because of possible life-threatening complications. These products include decongestants, expectorants, antihistamines and cough suppressants.

Just prior to that advisory, the makers of cough and cold remedies marketed for infants voluntarily recalled the products.

Despite scant evidence that such remedies are actually effective in children, or adults, an estimated 10 percent of American kids take one or more cough and cold medications during a given week.

Yet the preparations can do more harm than good, research suggests.

An FDA review of records filed with the agency between 1969 and September 2006 found 54 reports of deaths in children associated with decongestant medicines made with pseudoephedrine, phenylephrine or ephedrine. It also found 69 reports of deaths associated with antihistamine medicines containing diphenhydramine, brompheniramine or chlorpheniramine. Most of the deaths involved children younger than 2.

And the U.S. Centers for Disease Control and Prevention reported that some 7,000 American children under the age of 11 are treated each year in hospital emergency rooms because of problems with cough and cold medications.

More information

Visit the FDA for more on its recommendation regarding over-the-counter cough and cold medications for young children.

MONDAY, Oct. 6 (HealthDay News) -- Over the past two flu seasons, vaccinating children five and younger did not reduce the number of child hospitalizations or doctor's visits linked to influenza, according to results of a new study.

Given the poor match between the flu vaccine and circulating strains during the last two years, "this finding is not surprising," said Dr. Robert Belshe, a professor of medicine and pediatrics and director of the Center for Vaccine Development at the Saint Louis University Medical Center, who was not involved in the study.

"We know that the inactivated vaccine -- the flu shot -- doesn't work real well in children, particularly when the virus has evolved and drifted away from the type that is put in the vaccine," he said.

In contrast, the live attenuated vaccine given as a nasal spray is far more effective, Belshe contended. "A recent study showed that it is 50 percent more effective at protecting against flu, including these drifted viruses that don't match," he said.

Another study, this time in the October issue of Pediatrics, found that deaths caused by flu-linked staph infection are climbing among U.S. children, so the flu shot may still be important.

In June 2006, the Centers for Disease Control and Prevention (CDC) recommended for the first time that all children 6 months of age or older receive annual flu shots.

The new report was published in the October issue of the Archives of Pediatrics & Adolescent Medicine.

In the study, a team led by Dr. Peter G. Szilagyi, from the University of Rochester School of Medicine and Dentistry and Strong Memorial Hospital in Rochester, N.Y., looked at 414 children aged five and younger who developed flu in the 2003-2004 or 2004-2005 flu seasons.

Among these children, 245 were seen in hospitals or emergency departments, and 169 were cared for in a doctor's office or clinic. The researchers compared the vaccination status of these children with more than 5,000 children from the same area who did not get the flu.

Szilagyi's group found that children who got the flu were less likely to have been vaccinated, compared with children who didn't get sick.

However, after they adjusted for flu risk factors -- such as a child's location, sex, insurance status, chronic health conditions or timing of the vaccine -- the effectiveness of the vaccine could no longer be shown. The effectiveness of the flu shot ranged from 7 percent to 52 percent for 6- to 59-month-old children who had been fully vaccinated, the researchers found.

The less-than-perfect match between the strain of flu in the vaccine during the two seasons studied and the flu that was actually circulating may have contributed substantially to the poor effectiveness of the vaccine, Szilagyi's team speculated.

In 2003 to 2004, 99 percent of circulating flu was influenza A, but only 11 percent of the influenza A strain in the United States was similar to the strains included in the vaccine.

"The 2004-2005 season was less severe, and the vaccine was a better match to circulating strains than in 2003-2004, but still only 36 percent of virus isolates were antigenically similar to vaccine strains," the authors noted.

From September 2007 to April 2008, the CDC reported a total of 72 deaths from flu among children with many more hospitalized.

Belshe said that, for children over two, the nasal flu vaccine should be used instead of an injection. "It is recommended for children and adults, aged 2 to 49 who do not have asthma or recurrent wheezing -- that's about 80 percent of children," he said.

For younger children, "you're stuck with a flu shot -- no pun intended," Belshe said. "The flu shots should still be used. It probably modifies the severity of the illness, even though it doesn't protect completely against the illness itself -- it is important to take," he said.

Dr. William Schaffner, department chairman of the division of infectious disease and professor of preventive medicine at Vanderbilt University, noted that to be fully protected, young children need two doses of flu vaccine, which many don't get.

"Adults have had much more experience with both influenza and influenza vaccine," Schaffner added. "The likelihood that the vaccine is going to give you a boost in immunity is stronger in adults than it is in children," he said.

Schaffner noted that over the past 20 years, the match between the vaccine and the circulating flu virus has generally been good.

"In about four-fifths of the time, the experts have been pretty much on target, including the appropriate material in the vaccine. Occasionally, because the flu is fickle, it outfoxes those of us who select what's going to be in the vaccine," Schaffner said.

As for the coming flu season, the CDC in September announced that it was "optimistic" that the vaccine created this time around will be a closer match to circulating viruses.

"It's not a great vaccine, [but] it's a good vaccine. The best tool we have is the influenza vaccine -- recognizing that every once in a while, getting your influenza vaccine is not going to give you perfect protection," he said.

And any protection may be vital, according to the study in Pediatrics. In that work, researchers at the CDC analyzed data on pediatric flu deaths from the 2004-2005 season through to the 2006-2007 season.

They found that the number of kids who died of the flu over the three seasons rose from 47 and 46 in the first two years, to 73 in the 2006-2007 season. Many of the deaths were attributed to tough-to-treat staph infections. More than half of the children who died were between 5 and 17 years of age and had previously been healthy, the team noted.

The overall risk to an individual child is still very low, "but it's an important message to say even healthy children develop complications and die almost before anything much can be done for them," one vaccine specialist, the Mayo Clinic's Dr. Gregory Poland, told the Associated Press.

Schaffner stressed that vaccination is still important, but he agreed with Belshe that the nasal spray vaccine is better for children.

"The nasal spray vaccine provides broader protection against influenza virus variants than does the injectable vaccine," Schaffner said. "There are many of us who would like to see more children vaccinated and more nasal spray vaccine used. Any vaccine is better than none. Nasal spray vaccine should be used more frequently."

More information

For more about flu, visit the Centers for Disease Control and Prevention.