Global & Disaster Medicine

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CDC: Preparing Children with Special Healthcare Needs for an Emergency

CDC Resources


First and foremost, establish a personal support network or self-help team that is familiar with your child’s special healthcare needs, and available to help before, during, and after an emergency. Work with your team to identify the 7 key areas of support:

  1. Make arrangements prior to an emergency for your team to immediately check-in with you when disaster strikes.
  2. Exchange important keys or codes, such as, house keys, car keys, and garage door codes.
  3. Show them where you keep emergency supplies.
  4. Share copies of your emergency documents, evacuation plans and emergency health information card.
  5. Review and practice ways for contacting each other in an emergency.
  6. Notify your team when you have plans to travel, and make sure they know when you will return.
  7. Learn about each other’s needs and how you can help before, during and after an emergency.

In order to prepare your family and your team ahead of time, make sure you create an emergency care plan that considers the special needs of your child. For example, if your child has specific dietary needs or mobility limitations, make sure that your emergency plan has information on the kinds of food to avoid or a list of items that your child may need for his or her assistant devices (ex. Spare battery for an electric chair). It might also be helpful to create a kit or go-bag that has necessary back-up battery supplies, special non-perishable foods and special medicines. For example, if your child has asthma, make sure you have an adequate supply of asthma medications such as albuterol. You may also need to consider having spare albuterol inhalers at school and at home in case there’s an emergency.

Work with your healthcare provider and your child’s school to make sure they are aware of your child’s needs and have plans in place to accommodate those needs in case of an emergency. The American College of Emergency Physicians and the American Academy of Pediatrics developed an Emergency Information Form to help emergency care professionals and healthcare providers give appropriate care for children with special healthcare needs during an emergency.

Special education. Teddy bear hiding behind a blackboard. Special education text drawing on the blackboard


Each emergency is different and may require different actions to keep your family safe. Depending on the emergency, authorities may ask you to stay where you are by sheltering in place, or they may recommend that you evacuate.

The American Academy of Pediatrics advises that children with special health care needs need to have access to safe transportation, specifically family vehicles and school buses that are specific to their needs.

In order to do this, families, healthcare professionals, and school administrators need to be aware of the current guidelines for properly securing and transporting children of different ages, and with different physical and mental abilities.

Families and caretakers of children with special health care needs need to avoid using makeshift restraint systems or products that are not suitable to the child being transported.

When transporting a child with special healthcare needs, please consider the following:

  1. Place the child in the back seat of a motor vehicle.
  2. For a child who requires observation during travel, and for whom an adult is not available to ride in the back seat with, an air bag on/off switch may be considered for the vehicle.
  3. Follow all instructions by the manufacturer of the vehicle, and safety seat.
  4. Children with a medical problem should have a special care plan that details how to transport them during an emergency.
  5. Families of children with special healthcare needs need to properly install appropriate restraint systems in family vehicles and know how to use them.
  6. Parents, healthcare professionals, and educators should consider a child’s transportation needs and incorporate those needs into the child’s Individual Education Plan (IEP).


Each day, 69 million children in the United States attend childcare or school. As a caregiver you can protect your children by knowing their school or childcare center’s emergency plan.

If an emergency occurs during the school day, school authorities will activate their emergency action plan, which may include evacuating the children off site to a safer place or emergency shelter.

In situations such as this, wait until emergency or school authorities say it is safe for you to pick up your child. Do not go to your child’s childcare center or school during an emergency, doing so can put you and your child at greater risk. Instead, take steps now to help with reunification:

  • On an annual basis, make sure that your child’s school has up-to-date emergency contact information for your child. Be sure to notify the school every time your address or phone number changes.
  • Get a copy of your child’s school or child care center emergency plan. These will explain their evacuation plans, how the facility will contact you, and how you will be reunited with your child during or after an emergency.
  • Send your child to school with an updated backpack emergency card. It’s an easy way to share emergency contact information and can help when there is a communication barrier. Also, if your child is able, teach them how to call 9-1-1 and memorize important phone numbers.
  • Create reunification and communication plans that cater to your child’s special and specific needs. This may involve establishing non-verbal cues that will allow a child to communicate their needs to a trusted adult or peer.
  • Reviewing and practicing your plan with your team and family before an emergency will also help you recognize what might be missing from your plan.

The U.S. Department of Education’s Office of Safe and Supportive Schools (OSSS) and its Readiness and Emergency Management for Schools (REMS) Technical Assistance (TA) Center offers a variety of resources on the topics of reunification, access, and functional needs via web pages hosted on their website. Each page offers resources from the REMS TA Center and other national and Federal partners, including CDC that can support planning around these topics before, during, and after emergencies.


Thanks in advance for your questions and comments on this Public Health Matters post. Please note that the CDC does not give personal medical advice. If you are concerned you have a disease or condition, talk to your doctor.

Have a question for CDC? CDC-INFO ( offers live agents by phone and email to help you find the latest, reliable, and science-based health information on more than 750 health topics.

Posted on December 2, 2019 by Holly Gay

Oral Ondansetron Administration to Dehydrated Children in Pakistan: Latest research

Oral Ondansetron Administration to Dehydrated Children in Pakistan: A Randomized Clinical Trial

  Stephen B. Freedman, Sajid B. Soofi, Andrew R. Willan, Sarah
  Williamson-Urquhart, Emaduddin Siddiqui, Jianling Xie, Fady Dawoud and
  Zulfiqar A. Bhutta
  Pediatrics 2019; 144:e20192161
“A total of 918 dehydrated Pakistani children with
gastroenteritis-associated vomiting received oral ondansetron or placebo;
children administered ondansetron were less likely to vomit and receive
intravenous rehydration.”


Secret Service

“……Some of the key findings from this study, and their implications for informing school violence prevention efforts, include:
• There is no profile of a student attacker, nor is there a profile for the type of school that has been targeted:   Attackers varied in age, gender, race, grade level, academic performance, and social characteristics. Similarly,   there was no identified profile of the type of school impacted by targeted violence, as schools varied in size,   location, and student-teacher ratios. Rather than focusing on a set of traits or characteristics, a threat assessment     process should focus on gathering relevant information about a student’s behaviors, situational factors, and   circumstances to assess the risk of violence or other harmful outcomes.
•  Attackers usually had multiple motives, the most common involving a grievance with classmates: In addition to   grievances with classmates, attackers were also motivated by grievances involving school staff, romantic       relationships, or other personal issues. Other motives included a desire to kill, suicide, and seeking fame or   notoriety. Discovering a student’s motive for engaging in concerning behavior is critical to assessing the   student’s risk of engaging in violence and identifying appropriate interventions to change behavior and   manage risk.
•  Most attackers used firearms, and firearms were most often acquired from the home: Many of the attackers      were able to access firearms from the home of their parents or another close relative. While many of the firearms      were unsecured, in several cases the attackers were able to gain access to firearms that were secured in a locked   gun safe or case. It should be further noted, however, that some attackers used knives instead of firearms to      perpetrate their attacks. Therefore, a threat assessment should explore if a student has access to any weapons,      with a particular focus on weapons access at home. Schools, parents, and law enforcement must work together      rapidly to restrict access to weapons in those cases when students pose a risk of harm to themselves or others.
•  Most attackers had experienced psychological, behavioral, or developmental symptoms: The observable mental      health symptoms displayed by attackers prior to their attacks were divided into three main categories:   psychological (e.g., depressive symptoms or suicidal ideation), behavioral (e.g., defiance/misconduct or symptoms      of ADHD/ADD), and neurological/developmental (e.g., developmental delays or cognitive deficits). The fact that half
of the attackers had received one or more mental health services prior to their attack indicates that mental health   evaluations and treatments should be considered a component of a multidisciplinary threat assessment, but not   a replacement. Mental health professionals should be included in a collaborative threat assessment process that      also involves teachers, administrators, and law enforcement.
•  Half of the attackers had interests in violent topics: Violent interests, without an appropriate explanation, are   concerning, which means schools should not hesitate to initiate further information gathering, assessment, and      management of the student’s behavior. For example, a student who is preoccupied or fixated on topics like the      Columbine shooting or Hitler, as was noted in the backgrounds of several of the attackers in this study, may be the      focus of a school threat assessment to determine how such an interest originated and if the interest is negatively      impacting the student’s thinking and behavior.

•   All attackers experienced social stressors involving their relationships with peers and/or romantic partners:      Attackers experienced stressors in various areas of their lives, with nearly all experiencing at least one in the six   months prior to their attack, and half within two days of the attack. In addition to social stressors, other stressors      experienced by many of the attackers were related to families and conflicts in the home, academic or disciplinary      actions, or other personal issues. All school personnel should be trained to recognize signs of a student in crisis.   Additional training should focus on crisis intervention, teaching students skills to manage emotions and resolve      conflicts, and suicide prevention.
•  Nearly every attacker experienced negative home life factors: The negative home life factors experienced by      the attackers included parental divorce or separation, drug use or criminal charges among family members, or      domestic abuse. While none of the factors included here should be viewed as predictors that a student will be   violent, past research has identified an association between many of these types of factors and a range of negative     outcomes for children.
•  Most attackers were victims of bullying, which was often observed by others: Most of the attackers were   bullied by their classmates, and for over half of the attackers the bullying appeared to be of a persistent pattern   which lasted for weeks, months, or years. It is critical that schools implement comprehensive programs designed to     promote safe and positive school climates, where students feel empowered to report bullying when they witness it      or are victims of it, and where school officials and other authorities act to intervene.
• Most attackers had a history of school disciplinary actions, and many had prior contact with law enforcement:     Most attackers had a history of receiving school disciplinary actions resulting from a broad range of   inappropriate behavior. The most serious of those actions included the attacker being suspended, expelled, or      having law enforcement interactions as a result of their behavior at school. An important point for school staff      to consider is that punitive measures are not preventative. If a student elicits concern or poses a risk of harm      to self or others, removing the student from the school may not always be the safest option. To help in making      the determination regarding appropriate discipline, schools should employ disciplinary practices that ensure      fairness, transparency with the student and family, and appropriate follow-up.
• All attackers exhibited concerning behaviors. Most elicited concern from others, and most communicated their      intent to attack: The behaviors that elicited concern ranged from a constellation of lower-level concerns to   objectively concerning or prohibited behaviors. Most of the attackers communicated a prior threat to their target or      communicated their intentions to carry out an attack. In many cases, someone observed a threatening   communication or behavior but did not act, either out of fear, not believing the attacker, misjudging the immediacy or     location, or believing they had dissuaded the attacker. Students, school personnel, and family members should be      encouraged to report troubling or concerning behaviors to ensure that those in positions of authority can intervene.….”

Children, Food, and Nutrition: UNICEF

UNICEF: Document

“High rates of childhood obesity are a problem in a rising number of low- and middle-income countries, according to a new global assessment of child malnutrition by UNICEF. It’s the agency’s most comprehensive nutrition report in two decades.

The report paints a complex, dire picture of the state of children’s health. Overall, it found that around 200 million children under age 5, or 1 in 3 worldwide, are either undernourished or overweight. Wasting (below-average weight for height) and micronutrient deficiency remain persistent challenges in Africa and South Asia. Still, there’s some good news: Stunting (below-average height for age) has dropped sharply in the last two decades on every continent except Africa.

Meanwhile, at least 340 million adolescents worldwide between ages 5-19, and 40 million children under age 5, have been classified as overweight, the report found. The most profound increase has been in the 5-19 age group, where the global rate of overweight increased from 10.3% in 2000 to 18.4% in 2018…..”

9/3/2004: A three-day hostage crisis at a Russian school comes to a violent conclusion with the deaths of more than 300 people, many of them kids.



In celebration of World Breastfeeding Week


“……The benefits of breastfeeding don’t just extend to babies; studies found it can even protect women from breast and ovarian cancer later in life, reduce the risk of type 2 diabetes and contribute to healthy timing and spacing of pregnancies. In fact, scaling up breastfeeding could prevent over 800,000 child deaths and 20,000 deaths among women each year...…”

World Breastfeeding Week 2019


The cognitive, health and economic benefits of breastfeeding are well established and recognized, yet only 37 percent of children under 6-months-old in low- and middle-income countries are exclusively breastfed and about 50 percent of newborns initiate breastfeeding within one hour of birth.

Breastfeeding has one of the highest returns on investment of any development activity: every dollar invested in breastfeeding interventions yields an estimated $35 in economic gains. Breastfeeding duration is also associated with higher IQ and income as well as greater educational attainment. Inversely, suboptimal breastfeeding is associated with economic losses of about $302 billion each year, or 0.49 percent of world gross national income. With support to scale up global breastfeeding practices, the deaths of 823,000 children under 5-years-old and 20,000 women could be prevented, annually.

Causes of severe pneumonia requiring hospital admission in children around the world


“…….Between Aug 15, 2011, and Jan 30, 2014, we enrolled 4232 cases and 5119 community controls. The primary analysis group was comprised of 1769 (41·8% of 4232) cases without HIV infection and with positive chest x-rays and 5102 (99·7% of 5119) community controls without HIV infection.

Wheezing was present in 555 (31·7%) of 1752 cases (range by site 10·6–97·3%).

30-day case-fatality ratio was 6·4% (114 of 1769 cases).

Blood cultures were positive in 56 (3·2%) of 1749 cases, and Streptococcus pneumoniae was the most common bacteria isolated (19 [33·9%] of 56). Almost all cases (98·9%) and controls (98·0%) had at least one pathogen detected by PCR in the NP-OP specimen. The detection of respiratory syncytial virus (RSV), parainfluenza virus, human metapneumovirus, influenza virus, S pneumoniae, Haemophilus influenzae type b (Hib), H influenzae non-type b, and Pneumocystis jirovecii in NP-OP specimens was associated with case status.

The aetiology analysis estimated that viruses accounted for 61·4% (95% credible interval [CrI] 57·3–65·6) of causes, whereas bacteria accounted for 27·3% (23·3–31·6) and Mycobacterium tuberculosis for 5·9% (3·9–8·3).

Viruses were less common (54·5%, 95% CrI 47·4–61·5 vs 68·0%, 62·7–72·7) and bacteria more common (33·7%, 27·2–40·8 vs 22·8%, 18·3–27·6) in very severe pneumonia cases than in severe cases.

RSV had the greatest aetiological fraction (31·1%, 95% CrI 28·4–34·2) of all pathogens. Human rhinovirus, human metapneumovirus A or B, human parainfluenza virus, S pneumoniae, M tuberculosis, and H influenzae each accounted for 5% or more of the aetiological distribution. We observed differences in aetiological fraction by age for Bordetella pertussis, parainfluenza types 1 and 3, parechovirus–enterovirus, P jirovecii, RSV, rhinovirus, Staphylococcus aureus, and S pneumoniae, and differences by severity for RSV, S aureus, S pneumoniae, and parainfluenza type 3. The leading ten pathogens of each site accounted for 79% or more of the site’s aetiological fraction…..”

WHO: All about polio


Key facts

  • Polio (poliomyelitis) mainly affects children under 5 years of age.
  • 1 in 200 infections leads to irreversible paralysis. Among those paralysed, 5% to 10% die when their breathing muscles become immobilized.
  • Cases due to wild poliovirus have decreased by over 99% since 1988, from an estimated 350 000 cases then, to 33 (1) reported cases in 2018.
  • As long as a single child remains infected, children in all countries are at risk of contracting polio. Failure to eradicate polio from these last remaining strongholds could result in as many as 200 000 new cases every year, within 10 years, all over the world.
  • In most countries, the global effort has expanded capacities to tackle other infectious diseases by building effective surveillance and immunization systems.


Polio is a highly infectious disease caused by a virus. It invades the nervous system, and can cause total paralysis in a matter of hours. The virus is transmitted by person-to-person spread mainly through the faecal-oral route or, less frequently, by a common vehicle (for example, contaminated water or food) and multiplies in the intestine. Initial symptoms are fever, fatigue, headache, vomiting, stiffness of the neck and pain in the limbs. 1 in 200 infections leads to irreversible paralysis (usually in the legs). Among those paralysed, 5% to 10% die when their breathing muscles become immobilized.

People most at risk

Polio mainly affects children under 5 years of age.


There is no cure for polio, it can only be prevented. Polio vaccine, given multiple times, can protect a child for life.

Global caseload

Wild poliovirus cases have decreased by over 99% since 1988, from an estimated 350 000 cases in more than 125 endemic countries then, to 33 (1) reported cases in 2018.

Of the 3 strains of wild poliovirus (type 1, type 2, and type 3), wild poliovirus type 2 was eradicated in 1999 and no case of wild poliovirus type 3 has been found since the last reported case in Nigeria in November 2012.

WHO Response

Launch of the Global Polio Eradication Initiative

In 1988, the Forty-first World Health Assembly adopted a resolution for the worldwide eradication of polio. It marked the launch of the Global Polio Eradication Initiative (GPEI), spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF, and supported by key partners including the Bill & Melinda Gates Foundation. This followed the certification of the eradication of smallpox in 1980, progress during the 1980s towards elimination of the poliovirus in the Americas, and Rotary International’s commitment to raise funds to protect all children from the disease.


Overall, since the GPEI was launched, the number of cases has fallen by over 99%.

In 1994, the WHO Region of the Americas was certified polio-free, followed by the WHO Western Pacific Region in 2000 and the WHO European Region in June 2002. On 27 March 2014, the WHO South-East Asia Region was certified polio-free, meaning that transmission of wild poliovirus has been interrupted in this bloc of 11 countries stretching from Indonesia to India. This achievement marks a significant leap forward in global eradication, with 80% of the world’s population now living in certified polio-free regions.

More than 16 million people are able to walk today, who would otherwise have been paralysed. An estimated 1.5 million childhood deaths have been prevented, through the systematic administration of vitamin A during polio immunization activities.

Opportunity and risks: an emergency approach

The strategies for polio eradication work when they are fully implemented. This is clearly demonstrated by India’s success in stopping polio in January 2011, in arguably the most technically-challenging place, and polio-free certification of the entire South-East Asia Region of WHO occurred in March 2014.

Failure to implement strategic approaches, however, leads to ongoing transmission of the virus. Endemic transmission is continuing in Afghanistan, Nigeria and Pakistan. Failure to stop polio in these last remaining areas could result in as many as 200 000 new cases every year, within 10 years, all over the world.

Recognizing both the epidemiological opportunity and the significant risks of potential failure, the “Polio Eradication and Endgame Strategic Plan” was developed, in consultation with polio-affected countries, stakeholders, donors, partners and national and international advisory bodies. The new Plan was presented at a Global Vaccine Summit in Abu Dhabi, United Arab Emirates, at the end of April 2013. It is the first plan to eradicate all types of polio disease simultaneously – both due to wild poliovirus and due to vaccine-derived polioviruses.

Future benefits of polio eradication

Once polio is eradicated, the world can celebrate the delivery of a major global public good that will benefit all people equally, no matter where they live. Economic modelling has found that the eradication of polio would save at least US$ 40–50 billion, mostly in low-income countries. Most importantly, success will mean that no child will ever again suffer the terrible effects of lifelong polio-paralysis.

Mass distribution of azithromycin could be a strategy for reducing childhood mortality in parts of sub-Saharan Africa.


“… remains unclear how azithromycin might be preventing childhood deaths. “Thus far our general sense is that azithromycin may work better in places with the highest childhood mortality, and these places have a very high burden of infectious illnesses, so we think azithromycin very likely is treating a multitude of infections that might ultimately have caused a death,” he [study co-author and University of California-San Francisco ophthalmology professor Jeremy Keenan, MD, MPH] said.

Other theories include a benefit to childhood growth, a change in gut microbiota, or an anti-inflammatory effect…..”


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