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TUESDAY, April 29 (HealthDay News) -- New numbers show that more than a quarter of American toddlers may be under-vaccinated.

The study of children aged 19 months to 35 months found that missed doses account for about two-thirds of non-compliance to official recommendations. However, miss-timed doses are also an issue, according to a study conducted by the U.S. Centers for Disease Control and Prevention (CDC) and published in the June issue of the American Journal of Preventive Medicine.

Immunization delays put children at risk for a variety of vaccine-preventable diseases such as measles, mumps and chicken pox. On the other hand, immunization rates in the United States are decent, experts reasoned.

"Part of it depends on how you are slicing and dicing this," said Dr. Robert Frenck, professor of pediatrics at Cincinnati Children's Hospital and a committee member of the American Academy of Pediatrics' committee on infectious diseases. "If you look at children going into kindergarten [four to six years old], our immunization rates are as high or higher than they've ever been."

"This is a little bit of a wake-up call -- not a huge one -- that you need to make sure to do the best you can to get children vaccines when they're supposed to get them," added Dr. Paul Offit, director of the Vaccine Education Center and chief of infectious diseases at the Children's Hospital of Philadelphia. He stressed that "kids may catch up [when they're older]."

Parents and kids face a complicated schedule of vaccinations in the first years of life. Some might even say it's a logistical nightmare. This study was based on doses kids received in 2003 and 2004, at which time a toddler up to 18 months old should have received about 14 shots related to several different vaccines. Today, there are even more shots recommended.

For 50 years, the success of the vaccination program has been measured by whether or not children received the required number of doses.

"[But] the official recommendations for vaccination include more than just number of doses," said Elizabeth Luman, lead author of the study and an epidemiologist at the CDC's National Center for Immunization and Respiratory Diseases in Atlanta. They also include specific age recommendations and often multiple doses at different time intervals.

For this study, researchers looked at vaccination histories for more than 17,500 U.S. children aged 19 months to 35 months.

An estimated 72 percent of children in this age group finished the standard vaccination series. That was 9 percentage points lower than if coverage was based on counting doses only, the researchers noted.

Nineteen percent of children were missing one or more doses of vaccines; 8 percent had received an "invalid" dose, meaning it was given while the child was too young or too close to the previous dose.

About 3 percent of the sample had their last hepatitis B vaccine too early (before six months). Some also received their measles vaccine while they were still protected by their mother's antibodies. Another 3 percent received serial doses of one vaccine too close together.

"If children receive vaccines too close together or too early, they're not as likely to be protected, and if you have a lot of that, then you're more likely to have disease outbreaks," Luman said.

One reason for lack of strict adherence to the vaccine schedule may be a fading consciousness among today's parents of what these immunizations are protecting children against. Frenck said he remembers seeing a childhood friend in an iron lung, the result of polio.

"It scared me to death," he said. "Kids these days, and probably most adults, don't even known what an iron lung is -- and that's because of immunization."

So far, smallpox has been completely eradicated from the planet thanks to immunizations, while great gains have been made with measles and polio.

"People just need to keep their vigilance up," Frenck said. "We need to continue to review shot records and to go over it with parents whenever they come in. Opportunities for vaccination are missed a lot of times when kids come in for one reason or another, and we don't look at the immunization record. We need to continue to try to immunize kids whenever we have the opportunity."

More information

For more on vaccines and vaccine schedules, visit the CDC's Advisory Committee on Immunization Practices.

FRIDAY, April 25 (HealthDay News) -- Even when air pollution levels are within current air quality standards, inner-city children with asthma suffer, a new study finds.

The Inner City Asthma Study Group researchers, who looked at 861 children, ages 5 to 12, with persistent asthma, said their findings raise questions about current air quality standards in the United States. They suggest that asthma management plans for inner-city children may need to include reduced exposure to air pollutants.

For two years, the researchers monitored the asthma symptoms of children living in low-income inner-city sections of Boston, New York City, Chicago, Dallas, Seattle and Tucson.

These youngsters had significantly decreased lung function following exposure to higher concentrations of air pollutants such as sulfur dioxide, airborne fine particles, and nitrogen dioxide. The study also found that higher nitrogen dioxide levels and higher levels of fine particles were associated with asthma-related school absences, and that higher nitrogen dioxide levels were associated with an increase in asthma symptoms.

Since motor vehicle exhaust is the main source of nitrogen dioxide, the findings suggest that car emissions may be causing respiratory problems among inner-city children with asthma, the researchers said.

The study, supported by the U.S. National Institutes of Health and Environmental Protection Agency, was published in The Journal of Allergy and Clinical Immunology.

More information

The Nemours Foundation has more about air pollution and asthma  .

MONDAY, April 14 (HealthDay News) -- A record number of American girls are participating in sports, but their physical activity levels outside of organized sports are decreasing, especially as they go from childhood to adolescence, a new study concludes.

The authors, from the University of Minnesota Tucker Center for Research on Girls & Women in Sport, reviewed the most recent research conducted on a number of aspects of girls and sport/physical activity including: physical, psychological, social and cultural benefits; barriers that prevent girls from reaching their full potential; and environments that help girls learn how to develop and do well both on and off the playing field.

"The research ... confirms that many good things are happening when it comes to girls and physical activity. Girls are participating in organized sports more than ever and at all levels -- from organized youth sports, to interscholastic sports and up through Olympic competition," report co-author Nicole LaVoi, associate director of the Tucker Center, said in a prepared statement.

The report, released Monday by the university, noted that girls derive a number of benefits of regular physical activity:

• Improved health and lower risk of obesity and chronic diseases such as type 2 diabetes, osteoporosis and cardiovascular disease.
• Positive development, including social, psychological and motor skill benefits.
• Athletic girls do better academically and have lower dropout rates than non-athletic girls.

However, the report found that girls face many barriers, stereotypes and gender inequities when it comes to sports and physical activity.

"Poverty substantially limits many girls' access to, and participation in, physical activity and sport, especially for girls of color who are overrepresented in lower socioeconomic groups. So, while some girls are physically active, many girls fail to meet minimal standards of physical activity needed to accrue developmental and health benefits, or worse, they are completely sedentary. There remains a great deal of work left to be done," LaVoi said.

Among the other problems:

• Girls' participation rates in all types of physical activities consistently lag behind those of boys, and girl's dropout rates are higher.
• Girls' athletic experiences are shaped by the quality and expertise of adults who organize and supervise sports. However, many of those adults have minimal, if any, formal training.
• Outdated stereotypes of femininity and masculinity continue to affect girls' participation in physical activity.

"The United States as a whole -- from parents and coaches to school administrators and community leaders to policy makers -- needs to make a commitment to eliminating the barriers girls in this nation face when it comes to engaging in sports and physical activity. Physical activity is not an 'add-on' but rather is a core value and principle for healthy and effective living," Mary Jo Kane, director of the Tucker Center, said in a prepared statement.

More information

The Nemours Foundation has more about children and exercise  .

MONDAY, April 7 (HealthDay News) -- Adverse "drug events" -- including getting the wrong drugs, accidental overdoses and unfavorable reactions -- affect about 7 percent of U.S. children in hospitals, a new study says.

That figure is much higher than previous estimates. And it underscores growing concerns about medical errors involving hospitalized children -- an issue that generated headlines in November when actor Dennis Quaid's newborn twins were accidentally given life-threatening overdoses of a blood thinner.

"This gives us some valuable insight into the frequency of medication-related harm," said study lead author Dr. Paul Sharek, medical director of quality management at Stanford University's Lucile Packard Children's Hospital.

"The number is larger purely because of the way we collected the information before. But most of those who work in children's hospitals realize that because of the complexity of children's health care in the United States harm occurs," Sharek said.

The findings are published in the April issue of Pediatrics.

For the study, the researchers reviewed the charts of 960 randomly selected children from 12 children's hospitals around the United States. The new method of detecting medical errors was a list of 15 "triggers" that a patient's charts might indicate possible drug-related problems. The triggers included the use of antidotes for drug overdoses, suspicious side effects and lab tests.

The researchers found adverse drug events for 11.1 of every 100 hospitalized children. Earlier estimates, using standard measures, had placed adverse drug events at two for every 100 patients. Of these adverse drug reactions, 22 percent were preventable, 17.8 percent could have been identified earlier, and 16.8 percent could have been handled more effectively, the study found.

Fortunately, most of the adverse drug events -- 97 percent -- caused only minor, temporary harm. However, only 3.7 percent of these events were found in traditional hospital reports, according to the new study.

Most adverse events were rashes and nausea. The drugs that were most commonly misused were pain medications and antibiotics. Most common mistakes included not monitoring patients, prescribing the wrong medicine, or wrong doses, the researchers said.

The number of adverse drug events involving children is about the same as it is for adults, Sharek said.

Sharek said steps are being taken to help reduce the number of medication errors involving children. These include electronic medical records and bar coding, he said.

One of the 15 triggers is the use of vitamin K, which is an antidote for the blood-thinner Coumadin. Quaid's twins were given an accidental overdose of heparin in a Los Angeles hospital, shortly after they were born.

The twins recovered, and Quaid and his wife, Kimberly, have formed a foundation to help prevent medical errors. Quaid told the Associated Press that the twins "appear to be normal kids, very happy and healthy."

Quaid credited the new study with increasing awareness about the problem of pediatric medical errors. He said that, until the near death of his twins, he never thought he'd play a role as a public health advocate. He called the experience "the most frightening time," of his life, the AP said.

His message for parents: "Every time a caregiver comes into the room, I would check and ask the nurse what they're giving them and why," Quaid told the AP.

More information

For more on adverse drug reactions, visit the U.S. Food and Drug Administration.