Program Nasional bagi Anak Indonesia 2015

Sebagai komitmen negara  pihak yang ikut serta menandatangani deklarasi World Fit for Children (WFC)  pada sidang Umum PBB ke-27 tanggal 2 Mei  s/d  8 Mei 2002 di New York, Negara RI menyusun sebuah Naskah Rencana Aksi Nasional Untuk Mewujudkan Indonesia Yang Layak Bagi Anak dengan visi:

Terwujudnya Anak Indonesia yang sehat, tumbuh dan berkembang, cerdas ceria, berakhlak mulia dan terlindungi  dari diskriminasi, eksploitasi dan kekerasan dan aktip berpartisipasi dalam sebuah  kebijakan nasional yang di beri nama PROGRAM NASIONAL BAGI ANAK INDONESIA 2015 (PNBAI 2015).

Ada 4 bidang  pokok yang menjadi focus PNBAI 2015  yang mendapat perhatian khusus dalam deklarasi WFC  2002 tersebut, yaitu:  Promosi hidup sehat (promoting  healthy lives), penyediaan pendidikan yang berkualitas (providing quality education), perlindungan terhadap  perlakuan salah (abuse), eksploitasi dan kekerasan (protecting against abuse, exploitation and violence) dan penanggulangan HIV/AIDS (combating HIV/AIDS).

Selain itu, WFFC menekankan  beberapa prinsip yang mendasari gerakan global menciptakan  dunia yang layak  bagi anak. Prinsip-prinsip tersebut adalah:

1. Mengutamakan (kepentingan) anak-anak (put the children first);
2. Membasmi kemiskinan, berinvestasi untuk (kepentingan) anak-anak ( eradicate poverty: invest in children)
3. Tidak  seorang anak pun boleh  ditinggalkan dan / atau tertinggal (leave no child behind)
4. Memberikan  perhatian dan pengasuhan bagi semua anak (care for ever child);
5. Memberikan pendidikan bagi semua anak (educate every child);
6. Melindungi anak-anak dari segala bahaya dan eksploitasi (protect children from harm and exploitation)
7. Melindungi anak-anak dari peperangan (protect children from war)
8. Memberantas HIV dan AIDS (combat HIV/AIDS)
9. Mendengarkan  anak-anak dan pastikan pertisipasi  mereka (listen to children and ensure their participation);
10. Melindungi bumi (sumber daya alam) untuk (kepentingan) anak-anak (protect the earth for children).

Landasan

PNBAI 2015 dikembangkan berlandaskan pada beberapa prinsip dan kebijakan  yang telah  dikembangkan sebelumnya. Pertama-tama, program ini dikembangkan dengan berlandaskan pada Undang-undang Dasar 1945 pasal 28b dan 28 c. Landasan kedua adalah Undang-undang Republik Indonesia No. 23 Tahun 2002 tentang Perlindungan Anak (UU PA).  Undang-undang  tersebut menegaskan  hak-hak anak untuk memiliki  tingkat kesehatan yang optimal, memperoleh pendidikan dan mendapatkan  perlindungan. Ditegaskan pula tanggung jawab dan kewajiban orang tua  dan/atau wali/ pengasuh anak, keluarga, pemerintah dan masyarakat dalam pemenuhan  hak-hak anak tersebut. Penyusunan PNBAI 2015 juga memperhatikan sepenuhnya konvensi Hak-hak Anak (Convention on the Rights of the Child). Konvensi Hak-hak Anak (Convention on the Rights of the Child). Konvensi Hak –hak anak menekankan  beberapa prinsip dasar  dalam pemenuhan hak-hak anak, yaitu: non diskriminasi; kepentingan yang terbai bagi anak; hak untuk hidup, kelangsungan hidup dan perkembangan; dan menghargai pendapat anak.

Millenium Development Goals (MDG) merupakan salah satu rujukan dalam mengembangkan PNBAI 2015. MDG menetapkan 8 tujuan  utama, yaitu: eradikasi kemiskinan yang ekstrim dan kelaparan, penyelenggaraan pendidikan primer secara  universal, promis kesetaraan jender dan pemberdayaan perempuan, penurunan kematian anak, peningkatan  kesehatan ibu, pemberantasan HIV/AIDS, malaria dan penyakit-penyakit lain, pemastian kesinambungan lingkungan dan pembagunan kemitraan global untuk pembangunan.

Prinsip-prinsip Dasar

Batasan Usia

Berdasarkan Undang-undang  No. 23 tahun 2002  tentang Perlindungan Anak, pada Bab I Ketentuan Umum, pasal 1 ayat 1, yang dimaksud dengan anak adalah seseorang  yang belum berusia 18 (delapan belas) tahun, termasuk anak yang masih dalam kandungan.

Anak sebagai Modal Dasar

Hasil  Sensus Penduduk tahun 2000 menunjukkan bahwa proprosi jumlah anak dan remaja  berusia 0-14 tahun mencapai hampir 30 persen dari total penduduk, dan dengan menambahkan jumlah anak yang berusia 15-18 tahun, jumlah anak secara  keseluruhan  lebih dari 1/3 jumlah total penduduk Indonesia.

VISI PNBAI 2015

Anak Indonesia yang sehat, tumbuh dan berkembang, cerdas-ceria berakhlak mulia, terlindungi, dan aktif berpartisipasi

MISI PNBAI 2015

1. Menyediakan pelayanan kesehatan yang komprehensif, merata dan berkualitas, pemenuhan gizi seimbang, pencegahan penyakit  menular termasuk HIV dan AIDS, pengembangan  lingkungan dan perilaku hidup sehat.
2. Menyediakan pelayanan pendidikan yang merata, bermutu dan demoktratis bagi semua anak sejak usia dini.
3. Membangun sistem pelayanan sosial dasar dan hukum yang responsif terhadap kebutuhan anak agar dapat melindungi anak dari segala bentuk kekerasan, eksploitasi dan diskriminasi.
4. Membangun lingkungan  yang kondusif untuk menghargai pendapat  anak dan memberi kesempatan untuk  berpartisipasi sesuai dengan usia dan tahap perkembangan anak.

Kegiatan-kegiatan Pokok PNBAI 2015

1. Memastikan  adanya kebijakan dan peraturan perundang-undangan yang berpihak pada kepentingan anak sebagai bagian dari penguatan  sistem hukum dan melaksanakan upaya sosialisasi  peraturan  perundangan  tersebut ke segala lapisan masyarakat
2. Melakukan  advokasi  kepada   lembaga-lembaga  legislatif, unit-unit perencana, tenaga profesional, sektor-sektor terkait dan pihak swasta agar senantiasa mengutamakan program nasional bagi anak dalam rangka  pemenuhan hak-hak anak.
3. Mengembangkan peran  dan partisipasi  kelembagaan masyarakat, termasuk sektor media informasi, swasta dan LSM, sebagai  bagian dari upaya  meningkatkan  kemandirian keluarga, pemberdayaan masyarakat dan kemitraan dengan swasta dalam program nasional bagi anak.
4. Peningkatan kesadaran masyarkat  tentang peran dan status  perempuan dan keluarga bagi kesehatan anak; bahaya, penanggulangan dan dampak HIV dan AIDS; pendidikan anak, permasalahan penundaan usia perkawinan, masalah kesehatan  reproduksi dan jiwa anak serta remaja.
5. Memberikan  pelayanan yang bermutu dalam bidang  kesehatan, pendidikan, sosial, perlindungan dan pengembangan anakyang  menjangkau seluruh lapisan masyakarat termauk anak-anak  yang berasala dari daearah terpencil, anak-anak daerah kumuh, anak-anak jalanan dan kelompok anak-anak lain yang masih belum terjangkau pelayanan sosial dasar.

Salam,

Abby 

Mengapa Jadwal Imunisasi Berbeda-beda?

Mengapa jadwal imunisasi di beberapa praktek dokter, klinik atau rumah sakit berbeda-beda ?

Perbedaan jadwal imunisasi pada kurun waktu yang berbeda di beberapa praktek dokter antara lain karena: sumber rujukan yang berbeda, adanya modifikasi untuk memudahkan orangtua, atau pertimbangan khusus berdasarkan keadaan bayi dan anak pada saat itu. Sebaiknya menggunakan jadwal imunisasi terbaru yang direkomendasikan oleh Satgas Imunisasi IDAI, karena dievaluasi secara periodik dengan mempertimbangkan perubahan epidemiologi penyakit tertentu, adanya vaksin-vaksin baru yang resmi beredar di Indonesia dan negara tetangga serta memperhatikan anjuran dari WHO (Badan Kesehatan Dunia),

Jadwal imunisasi mana yang terbaik ?

Jadwal yang terbaik adalah yang masih di dalam rentang umur Jadwal Imunisasi PPI Depkes maupun Rekomendasi Satgas Imunisasi PP IDAI. Namun harus dipertimbangkan pula hal-hal lain : keadaan dan riwayat bayi/anak yang berkaitan dengan indikasi kontra atau risiko kejadian ikutan pasca imunisasi, serta permintaan orangtua (misalnya vaksinasi cacar air sebelum umur 10 tahun). Berdasarkan pertimbanganpertimbangan tersebut dokter dapat melakukan penyesuaian untuk kepentingan bayi / anak, disertai penjelasan kepada orangtua.

Jika umur bayi atau anak sudah lebih dari umur yang dianjurkan dalam jadwal imunisasi, apakah boleh divaksin sesuai jadwal tersebut ?

Boleh, tidak berbahaya, karena anak yang belum mendapat imunisasi sesuai jadwal, berarti belum mempunyai kekebalan terhadap penyakit tersebut. Tetapi kalau umurnya sudah terlewat jauh beberapa tahun, untuk beberapa penyakit tertentu mungkin kurang penting, karena kemungkinan tertular semakin kecil. Tetapi ada penyakit tertentu yang tetap penting, walaupun sudah terlewat jauh. Untuk itu diskusikan dengan dokter, untuk mengejar imunisasi yang terlewatkan.

Jika sudah diimunisasi lengkap pada usia balita, apakah di sekolah perlu diimunisasi lagi ? Mengapa perlu ?

Imunisasi yang perlu diberikan ulangan pada sekolah dasar yaitu imunisasi campak dan DT (kelas 1), dan TT (kelas 2, 3, dan 6). Banyak anak yang sudah divaksinasi campak ketika bayi ternyata pada umur 5 – 7 tahun 28.3% masih terkena campak. Pada umur > 10 tahun masih banyak dijumpai kasus difteri. Untuk pemberantasan tetanus neonatorum sedikitnya dibutuhkan 5 kali suntikan tetanus toksoid sejak bayi sampai dewasa, sehingga kekebalan pada umur dewasa akan berlangsung sekitar 20 tahun lagi (lihat Bab IV tentang Jadwal Imunisasi)

Bayi prematur, apakah imunisasi harus ditunda ?

Ya, vaksin polio oral sebaiknya diberikan sesudah bayi prematur berumur 2 bulan, demikian pula DTP, hepatitis B dan Hib.

Anemia Defisiensi Besi pada Anak dan Remaja

Anemia defisiensi besi (ADB) merupakan  masalah defisiensi nutrien tersering pada anak di seluruh dunia terutama di negara sedang berkembang termasuk Indonesia. Penyakit ini disebabkan oleh kurangnya zat besi dalam tubuh penderita.

Secara epidemiologi, prevalens tertinggi ditemukan pada akhir masa bayi dan awal masa kanak-kanak diantaranya karena terdapat defisiensi besi saat kehamilan dan percepatan tumbuh masa kanak-kanak yang disertai  rendahnya asupan besi dari makanan, atau karena penggunaan susu formula dengan kadar besi kurang. Selain itu ADB juga banyak ditemukan pada masa remaja akibat percepatan tumbuh, asupan besi yang tidak adekuat dan diperberat oleh kehilangan darah akibat menstruasi pada remaja puteri. Data SKRT tahun 2007 menunjukkan prevalens ADB . Angka kejadian anemia defisiensi besi (ADB) pada anak balita di Indonesia sekitar 40-45%. Survey Kesehatan Rumah Tangga (SKRT) tahun 2001 menunjukkan prevalens ADB pada bayi 0-6 bulan, bayi 6-12 bulan, dan anak balita berturut-turut sebesar 61,3%, 64,8% dan 48,1%.

a. Fungsi zat besi yang paling penting adalah dalam perkembangan system saraf yaitu diperlukan dalam proses mielinisasi, neurotransmitter, dendritogenesis dan metabolism saraf.

b. Kekurangan zat besi sangat mempengaruhi fungsi kognitif, tingkah laku dan pertumbuhan seorang bayi. Besi juga merupakan sumber energy bagi otot sehingga mempengaruhi ketahanan fisik dan kemampuan bekerja terutama pada remaja.

c. Bila kekurangan zat besi terjadi pada masa kehamilan maka akan meningkatkan risiko perinatal serta mortalitas bayi.

d. Gejala yang paling sering ditemukan adalah pucat yang berlangsung lama (kronis) dan dapat ditemukan gejala komplikasi, a.l. lemas, mudah lelah, mudah infeksi, gangguan prestasi belajar, menurunnya daya tahan tubuh terhadap infeksi dan gangguan perilaku.

Penyebab defisiensi besi menurut umur

 Bayi kurang dari 1 tahun

1. Cadangan besi kurang, a.l. karena bayi berat lahir rendah, prematuritas, lahir kembar, ASI eksklusif  tanpa suplementasi besi, susu formula rendah besi, pertumbuhan cepat dan anemia selama kehamilan.
2. Alergi protein susu sapi

Anak umur 1-2 tahun

1. Asupan besi kurang akibat tidak mendapat makanan tambahan atau minum susu murni berlebih.
2. Obesitas
3. Kebutuhan meningkat karena infeksi berulang / kronis.
4. Malabsorbsi.

Anak umur 2-5 tahun

1. Asupan besi kurang karena jenis makanan kurang mengandung Fe jenis heme atau minum susu berlebihan.
2. Obesitas
3. Kebutuhan meningkat karena infeksi berulang / kronis baik bakteri, virus ataupun parasit).
4. Kehilangan berlebihan akibat perdarahan (divertikulum Meckel / poliposis dsb).

Anak umur 5 tahun-remaja

1. Kehilangan berlebihan akibat perdarahan(a.l infestasi cacing tambang) dan
2. Menstruasi berlebihan pada remaja puteri.

Penanganan anak dengan anemia defisiensi besi yaitu :

1. Mengatasi faktor penyebab.
2. Pemberian preparat besi

a. Oral

• - Dapat diberikan secara oral berupa besi elemental dengan dosis 3 mg/kgBB sebelum makan atau 5 mg/kgBB setelah makan dibagi dalam 2 dosis.
• - Diberikan sampai 2-3 bulan sejak Hb kembali normal
• - Pemberian vitamin C 2X50 mg/hari untuk meningkatkan absorbsi besi.
• - Pemberian asam folat 2X 5-10 mg/hari untuk meningkatkan aktifitas eritropoiesis
• - Hindari makanan yang menghambat absorpsi besi (teh, susu murni, kuning telur, serat) dan obat seperti antasida dan kloramfenikol.
• - Banyak minum untuk mencegah terjadinya konstipasi (efek samping pemberian preparat besi)

b. Parenteral

Indikasi:

• - Adanya mal-absorbsi
• - Membutuhkan kenaikan kadar besi yang cepat (pada pasien yang menjalani dialisis yang memerlukan eritropoetin)
• - Intoleransi terhadap pemberian preparat besi oral
• 
  

Pencegahan

1. Pendidikan

Meningkatkan pengetahuan masyarakat :

a. Tentang gizi dan jenis makanan yang mengandung kadar besi yang tinggi dan absorpsi yang lebih baik misalnya ikan, hati dan daging.

b. Kandungan besi dalam ASI lebih rendah dibandingkan dengan susu sapi tetapi penyerapan/bioavailabilitasnya lebih tinggi (50%). Oleh karena itu pemberian ASI ekslusif perlu digalakkan dengan pemberian suplementasi besi dan makanan tambahan sesuai usia.

c. Penyuluhan mengenai kebersihan lingkungan untuk mengurangi kemungkinan terjadinya infeksi bakteri/infestasi parasit sebagai salah satu penyebab defisiensi besi.

2. Suplementasi besi:

Diberikan pada semua golongan umur dimulai sejak bayi hingga remaja

Salam,

Abby

Imunisasi yukkk..

Imunisasi merupakan upaya pencegahan yang amat bermanfaat untuk mencegah penyakit infeksi yang dapat dicegah dengan imunisasi. Tujuan imunisasi adalah untuk melindungi anak atau individu dari penyakit tertentu, menurunkan angka kejadian penyakit dan pada akhirnya mengeradikasi suatu penyakit. Cacar (variola, smallpox) adalah suatu penyakit yang fatal pada abad ke 19. Berkat program imunisasi yang terus menerus, penyakit ini dapat dieradikasi dan dunia dinyatakan bebas cacar pada tahun 1979.

Imunisasi merupakan suatu teknologi yang sangat berhasil di dunia kedokteran yang oleh Katz (1999) dikatakan sebagai ”sumbangan ilmu pengetahuan yang terbaik yang pernah diberikan para ilmuwan di dunia ini”. Imunisasi merupakan satu upaya kesehatan yang paling efektif dan efisien dibanding dengan upaya kesehatan lainnya.

Dalam masyarakat, baik di Indonesia maupun di luar negeri, sering kali terdengar pendapat atau persepsi yang keliru tentang imunisasi, di antaranya adalah:

Penyakit telah menghilang sebelum vaksin diperkenalkan, akibat perbaikan sanitasi dan higiene. Dengan demikian, tidak perlu imunisasi.

Pengamatan difteria di Eropa setelah perang dunia ke II menunjukkan penurunan angka kejadian penyakit, sejalan dengan perbaikan sanitasi dan higiene. Namun penurunan penyakit difteria yang permanen baru tampak setelah program imunisasi dijalankan secara luas. Kondisi sosial ekonomi yang membaik mempunyai dampak positif bagi penyakit. Nutrisi yang cukup, penemuan antibiotik, telah meningkatkan angka harapan hidup bagi pasien. Kepadatan penduduk yang berkurang, telah menurunkan penularan penyakit. Angka kelahiran yang menurun juga telah menurunkan jumlah anak yang rentan dan menurunkan penularan dalam dan antar keluarga. Pengamatan angka kejadian penyakit jangka panjang dapat menerangkan dampak imunisasi dalam menurunkan penyakit.

Pengalaman negara maju, seperti Inggris, Swedia dan Jepang, menunjukkan bahwa penghentian program imunisasi pertusis (batuk rejan, batuk 100 hari) karena kekhawatiran terhadap efek samping vaksin, menimbulkan dampak peningkatan penyakit pertusis. Di Inggris, penurunan imunisasi pertusis pada tahun 1974 diikuti oleh epidemi pertusis dengan lebih dari 100.000 kasus dan 36 meninggal pada tahun 1978. Di Jepang pada kurun waktu yang hampir sama, terjadi penurunan cakupan imunisasi pertusis dari 70% menjadi 20%-40%. Hal itu diikuti dengan peningkatan kasus pertusis dari 393 dan tanpa kematian pada tahun 1974 menjadi 13.000 kasus pertusis dan 41 meninggal pada tahun 1979. Di Swedia, angka kejadian pertusis per 100.000 anak umur 0-6 tahun meningkat dari 700 kasus pada tahun 1981 menjadi 3.200 pada tahun 1985.

Untuk penyakit difteria, dapat dikaji data propinsi Ontario, Kanada yang mempunyai data morbiditas, mortalitas dan case fatality rate untuk kurun waktu 1880-1940. Sebelum ditemukan antitoksin difteria, mortalitas difteria melampaui 50 per 100.000 populasi pada masa tersebut. Mortalitas menurun menjadi sekitar 15 per 100.000 pada Perang Dunia I, meski pun angka morbiditas tidak menurun. Setelah penggunaan toksoid difteri secara luas pada akhir tahun 1920, penyakit difteria menurun drastis.

Dari pengalaman tersebut jelas bahwa dampak imunisasi lebih besar daripada perbaikan sanitasi. Penghentian imunisasi akan meningkatkan kembali angka kejadian penyakit. Dengan demikian imunisasi amat penting dan berguna untuk mencegah penyakit.

Beberapa hal yang perlu diketahui tentang Imunisasi

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1. Tujuan Imunisasi adalah membentuk kekebalan demi mencegah penyakit pada diri sendiri dan orang lain sehingga kejadian penyakit menular menurun dan bahkan dapat menghilang dari muka bumi. Kekebalan dapat disalurkan oleh ibu ke bayi yang dikandung tetapi tidak berlangsung lama, maka kekebalan harus dibentuk melalui pemberian imunisasi pada bayi.
2. Upaya pencegahan melalui vaksinasi telah dilakukan sejak lima abad yang lalu.
3. Untuk membuat vaksin yang aman dan berkhasiat jangka panjang, diperlukan suatu rangkaian penelitian yang cukup lama dan berhati-hati. Maka perlu disyukuri bahwa para ahli selalu berusaha mencari vaksin yang terbaik untuk meningkatkan kesehatan masyarakat di seluruh dunia.
4. Untuk menjaga mutu, vaksin disimpan dan didistribusikan dalam suhu 2^o – 8^o C sebelum digunakan (cold-chain atau rantai dingin). Selanjutnya cara pemberian vaksin yang benar diperlukan untuk mendapatkan kadar kekebalan yang tinggi dalam jangka panjang. Serta mengurangi efek samping.
5. Berbagai penyakit infeksi berat yang dapat menyebabkan kematian dan kecacatan dapat di cegah dengan pemberian imunisasi.
6. Saat pemberian imunisasi yang paling tepat adalah sebelum anak terpapar penyakit berbahaya.
7. untuk mendapat daya kekebalan yang prima, taatilah jadwal imunisasi.

Surat Persetujuan (informed consent)

Di dalam Peraturan Menteri Kesehatan (Permenkes) no. 585 tahun 1989 tentang Persetujuan Tindakan Medik dinyatakan bahwa informed consent adalah perse-tujuan yang diberikan oleh pasien atau keluarganya atas dasar penjelasan mengenai tindakan medik yang akan dilakukan terhadap pasien tersebut (pasal 1 ayat a).

• Informasi harus diberikan kepada pasien baik diminta ataupun tidak diminta (pasal 4 ayat 1)
• Semua tindakan medik yang akan dilakukan terhadap pasien harus mendapat persetujuan (pasal 2 ayat 2)
• Apabila tindakan medik dilakukan tanpa adanya persetujuan dari pasien atau keluarganya, maka dokter dapat dikenakan sanksi administratif berupa pencabutan izin prakteknya (pasal 13)

Di dalam Permenkes tersebut yang dimaksud dengan tindakan medik adalah tindakan diagnostik atau terapeutik (pasal 1, ayat b), sehingga ada yang berpendapat bahwa imunisasi tidak perlu persetujuan tindakan medis. Namun, di Amerika dan Australia persetujuan tindakan medik sebelum imunisasi dianggap perlu, walaupun tidak harus tertulis. The American Academy of Pediatrics (AAP) menganjurkan pemberian (berupa brosur) yang disusun dan disediakan oleh pemerintah bekerjasama dengan AAP dan produsen vaksin. Selain itu AAP menganjurkan agar setiap kali pemberian imunisasi orangtua menandatangani persetujuan tertulis, atau dicatat dalam catatan medik bahwa penjelasan telah dilakukan dan difahami oleh orangtua. 

The Australian National Health and Medical Research Council (NHMRC) juga menganjurkan agar setiap kali sebelum imunisasi diberikan penjelasan  tertulis di samping penjelasan lisan. Pada imunisasi perorangan orangtua diberi daftar isian (kuesioner) dan keterangan tertulis tentang perbandingan risiko imunisasi dan bahaya penyakit yang dapat dicegah dengan vaksin tersebut untuk dibaca dan didiskusikan dengan dokter. Tidak ada keharusan untuk mendapatkan persetujuan tertulis dari orangtua, cukup dicatat di dalam catatan medik bahwa orangtua telah diberikan penjelasan. Namun beberapa klinik  meminta persetujuan tertulis. Imunisasi masal (di sekolah) dilakukan setelah ada persetujuan tertulis dari orangtua. Namun jika orangtua hadir dibutuhkan persetujuan lisan dari orangtua. Namun jika orangtua hadir dibutuhkan persetujuan lisan dari orangtua walaupun telah ada persetujuan tertulis pada imunisasi sebelumnya.

Sejalan dengan peningkatan pendidikan dan pengetahuan masyarakat serta kesadaran konsumen tentang hak-haknya, dihimbau kepada anggota IDAI sebelum melakukan imunisasi sebaiknya memberikan penjelasan bahwa imunisasi berguna untuk melindungi anak terhadap bahaya penyakit  mempunyai manfaat lebih besar dibandingkan dengan risiko kejadian ikutan yang dapat ditimbulkannya (sesuai maksud pasal 2 ayat 3 Permenkes 585/1989). Cara penyampaian dan isi informasi disesuaikan dengan tingkat pendidikan serta kondisi dan situasi pasien (Permenkes 585/1989, pasal 2 ayat 4). Imunisasi yang dilaksanakan sesuai dengan program pemerintah untuk kepentingan masyarakat banyak (di Posyandu, Puskesmas) tidak diperlukan persetujuan tindakan medik (sesuai Permenkes 585/1989 pasal 14).
    
Hal-hal yang Perlu Diperhatikan pada Bayi/ Anak Sebelum Imunisasi
Orangtua atau pengantar bayi /  anak dianjurkan dan memberitahukan hal-hal tersebut di bawah ini secara lisan tentang hal-hal yang berkaitan dengan indikasi kontra atau risiko kejadian ikutan pasca imunisasi tersebut di bawah ini,

• - pernah mengalami kejadian ikutan pasca imunisasi yang berat pada imunisasi sebelumnya,
• - alergi terhadap bahan yang juga terdapat di dalam vaksin,
• - sedang mendapat pengobatan steroid, radioterapi atau kemoterapi,
• - menderita sakit yang menurunkan imunitas (leukimia, kanker, HIV/AIDS),
• - tinggal serumah dengan orang lain yang imunitasnya menurun (leukimia, kanker, HIV / AIDS),
• - tinggal serumah dengan oang lain dalam pengobatan yang menurunkan imunitas (radioterapi, kemoterapi, atau terapi steroid)
• - pada bulan lalu mendapat imunisasi yang berisi vaksin virus hidup (vaksin campak, poliomielitis, rubela)
• - pada 3 bulan yang lalu mendapat imunoglobulin atau transfusi darah

Pemberian Parasetamol Sesudah Imunisasi
Untuk mengurangi ketidaknyamanan pasca vaksinasi, dipertimbangkan untuk pemberian parasetamol 15 mg/kgbb kepada bayi/anak setelah imunisasi, terutama pasca vaksinasi DPT. Kemudian dilanjutkan setiap 3-4 jam sesuai kebutuhan, maksimal 4 kali dalam 24 jam. Jika keluhan masih berlanjut, diminta segera kembali kepada dokter.

Reaksi KIPI

Orangtua atau pengantar perlu diberitahu bahwa setelah imunisasi dapat timbul reaksi lokal di tempat penyuntikan  atau reaksi umum berupa keluhan dan gejala tertentu, tergantung pada jenis vaksinnya. Reaksi tersebut umumnya ringan, mudah diatasi oleh orangtua atau pengasuh , dan akan hilang dalam 1 – 2 hari. Di tempat suntikan kadang-kadang timbul kemerahan, pembekakan, gatal, nyeri selama 1 sampai 2 hari. Kompres hangat dapat mengurangi keadaan tersebut. Kadang-kadang teraba benjolan kecil yang agak keras selama beberapa minggu atau lebih, tetapi umunya tidak perlu dilakukan tindakan apapun.

BCG

Orangtua atau pengantar perlu diberitahu bahwa 2-6 minggu setelah imunisasi BCG dapat timbul bisul kecil (papula) yang semakin membesar dan dapat terjadi ulserasi selama 2-4 bulan, kemudian menyembuh perlahan dengan menimbulkan jaringan parut. Bila ulkus mengeluarkan cairan orangtua dapat mengkompres dengan cairan antiseptik. Bila cairan bertambah banyak, koreng semakin membesar atau timbul pembesaran kelenjar regional (aksila), orangtua harus membawanya ke dokter.

Hepatitis B

Kejadian ikutan pasca imunisasi pada hepatitis B jarang terjadi, segera setelah imunisasi dapat timbul demam yang tidak tinggi, pada tempat penyuntikan timbul kemerahan, pembengkakan, nyeri, rasa mual dan nyeri sendi. Orangtua / pengasuh dianjurkan untuk memberikan minum lebih banyak (ASI atau air buah), jika demam pakailah pakaian yang tipis, bekas suntikan yang nyeri dapat dikompres air dingin, jika demam berikan parasetamol 15 mg/kgbb setiap 3 – 4 jam bila diperlukan, maksimal 6 kali dalam 24 jam bila diperlukan, maksimal 6 kali dalam 24 jam, boleh  mandi atau cukup diseka dengan air hangat. Jika reaksi tersebut menjdai berat dan menetap, atau jika orangtua merasa khawatir, bawalah bayi / anak ke dokter.

DPT

Reaksi  yang dapat terjadi segera setelah vaksinasi DPT antara lain demam tinggi, rewel, di tempat suntikan  timbul kemerahan, nyeri dan pembengkakan, yang akan hilang dalam 2 hari. Orangtua / pengaruh dianjurkan untuk memberikan minum lebih banyak (ASI atau air buah), jika demam pakailah pakaian yang tipis, bekas suntikan yang nyeri dapat dikompres air dingin, jika demam berikan parasetamol 15 kg/kgbb setiap 3 – 4 jam bila diperlukan, maksimal 6 kali dalam 24 jam, boleh mandi atau cukup diseka dengan air hangat. Jika reaksi-reaksi tersebut berat dan menetap, atau jika orangtua  merasa khawatir, bawalah bayi / anak ke dokter.

DT

Reaksi yang dapat terjadi pasca vaksinasi DT antara lain kemerahan, pembengkakan dan nyeri pada bekas suntikan. Bekas suntikan yang nyeri dapat dikompres dengan air dingin . Biasanya tidak perlu tindakan khusus.

Polio Oral

Sangat jarang terjadi reaksi sesudah imunisasi polio, oleh karena itu orangtua / pengasuh tidak perlu melakukan tindakan apapun.

Campak dan MMR

Reaksi yang dapat terjadi pasca vaksinasi campak dan MMR berupa rasa tidak nyaman di bekas penyuntikan vaksin. Selain itu dapat terjadi gejala-gejala lain yang timbul 5 12 hari setelah penyuntikan, yaitu demam tidak tinggi atau erupsi kulit halus/tipis yang berlangsung kurang dari 48 jam. Pembengkakan kelenjar getah bening di belakang telinga dapat terjadi sekitar 3 minggu pasca imunisasi MMR. Orangtua / pengasuh dianjurkan untuk memberikan minum lebih banyak (ASI atau air buah), jika demam pakailah pakaian yang tipis, bekas suntikan yang nyeri dapat dikompres air dingin, jika demam diberikan parasetamol 15 mg/kgbb setiap 3 – 4 jam bila diperlukan, maksimal 6 kali dalam 24 jam, boleh mandi atau cukup diseka dengan air hangat. Jika  reaksi-reaksi tersebut berat dan menetap, atau jika orangtua merasa khawatir, bawalah bayi / anak ke dokter.

Salam,

Abby

Why Parents Must Find Opportunities To Talk

Lydia comes into my counselling room, concerned about her son, Danny. We talk. It emerges that she’s already doing all sorts of sensible things to support him. The trouble is that she can only do so much: there comes a point at which she has to let him make his own mistakes. And that’s the agony, made worse by the fact that her own mother has always been so critical of Lydia as a parent and Lydia feels so angry with Danny and angry with his father for contributing so little. She feels lonely, she says, despite having lots of friends. And all these feelings somehow get in the way when she’s trying to think clearly about her son, causing her sometimes to over-react, to panic and despair. And then Danny thinks she hates him and then she hates herself, she says, because she never set out to be like this. “I wonder, could you see him for counselling?”

I ask her if she’s mentioned it to Danny.

She hasn’t.

“Would he be interested?”

“Doubt it!”

I say that there’s no point in forcing him. He’s dealing with life in his own way. But I ask whether she’s ever thought of getting some support for herself. “Counselling, perhaps?”

“Do you think it would help?”

“It might…. Not necessarily to get lots of advice,” I say, “but to think with someone about your own life – your disappointments, your anger, the people who don’t support you.”

“It’s funny,” she says, “but Danny reminds me so much of myself at that age!”

Young people are often very good at getting their parents to feel their own worst feelings (their fear of the future, their anger at all the things that won’t be controlled) and parents are always likely to be doing the same thing, unconsciously getting their children to feel what it’s like to be disappointed, to feel that life is being wasted.

I don’t know Danny but imagine that, like all young people, he’s passionate about being given a second chance. Or a third, fourth or fifth chance for that matter. I imagine that he’s passionate about adults not holding grudges against him. But it can be hard to forgive our children for not being perfect, for not being like us or for being exactly like us! It can be hard to manage these feelings with equanimity, especially when we’re on our own or feel on our own.

Sometimes we need to look after ourselves in order to look after our children. Not by giving ourselves lots of presents or holidays but by getting some proper support for ourselves because being a parent can be a lonely job. We rarely feel that we’re getting it right. We’re expected to be experts on our own children when we can’t be - at least, not all the time. We’re learning as we go along, making mistakes and never getting any praise for all the good things we might be doing. “It might feel good having someone to talk with about how you’re feeling,” I say to Lydia. “It might help to keep things in perspective.”

Nick Luxmoore is a counselor at King Alfred's College, in the UK.


Love,
Abby

Saying One Thing and Meaning Your Mother

School’s boring! School doesn’t understand! School’s only interested in exams! School’s unfair to boys! School doesn’t care…! The vehemence with which young people talk about ‘school’ suggests that whatever it is that they mean by ‘school’ is much more powerful and personal than a collection of disparate buildings or an array of teachers trying their best and sometimes getting it wrong.

Peter says of his teachers, “They don’t care about us! They only care about themselves!”

“This school picks on people for no reason!” says Anna. “You can’t do anything! And there are some people never get the blame for anything! It’s always us!”

‘School’ is the recipient of all sorts of projections but because school is ‘in loco parentis’ —responsible for guiding and looking after young people—it picks up more than its share of parental transferences. Whenever young people like Peter and Anna are exercised on the subject of ‘school’, there’s a sense in which they’re unconsciously always talking about qualities of parenting, typically ‘fairness’ or ‘caring’ or sincerity. The same goes for the conversations and debates that the rest of us have about other organisations with any sort of nurturing role in our lives. Whatever their shortcomings, hospitals, the police, social workers, politicians and even banks stand accused of the worst crime: being bad parents. We may have elaborate reasons why we believe that this organisation or those workers aren’t doing their jobs properly (and, of course, there’s often objective truth in our accusations) but it’s hard for our views not also to be informed—unconsciously—by our personal experiences of parenting.

Given this, there are some professionals who—like anxious, insecure parents—retaliate angrily, hurt but these seemingly personal and unfair attacks. But the best professionals, like the best parents, seem able to bear the projections, knowing that they’re not as personal as they feel. Good teachers know that they’ll never get it right in the eyes of young people; they’ll always be accused of some new inadequacy. And it won’t just be the young people in their classes making the accusations. The criticisms will be just as fervent from the parents of those young people. After all, when we’re worrying about our own parenting skills, what could be easier than to lash out at other parent-figures? Make them take the blame! Make them feel the pain!

Typically, Peter and Anna will claim that their own parents are wonderful; it’s just ‘school’ that’s the problem. And typically their parents—launching some new attack on ‘school’—will also claim that everything’s fine at home; it’s just ‘school’ that’s the problem.

Helping young people to contain this good-bad splitting, helping them to live with the imperfections of their own parents and with the imperfections of the many parent-figures they encounter in their lives is difficult work. But until young people can do this, it’s hard for them ever to accept the imperfections in themselves.

Nick Luxmoore is a counselor at King Alfred's College, in the UK.


Love,
Abby

How Damaging Can the Media Be? by George Drinka, M.D.

For decades, social researchers have debated the dangers of children’s exposure to media violence. An average parent might ask, “How dangerous can the media really be?”

In a recent article in Newsroom America, we learn of an international Media Violence Commission. After much deliberation, this scholarly group concludes: “Violent images…act as triggers for actively aggressive thoughts and feelings already stored in memory.” Their statement goes further: “If these aggressive thoughts and feelings are activated over and over again because of repeated exposure to media violence, they become chronically accessible, and thus are likely to influence behavior.” Upon reading this article, one could easily assume that we are dealing with settled science, and that children’s exposure to violent media will have serious consequences.

However, another recent article by Jay Gield of the National Institute of Health reviews this same material and seems to disagree. Gield recalls how, not long ago, the California legislature passed a law to limit access of minors to violent video games. In response to this perceived infringement on their business, the gaming industry took an appeal all the way to the Supreme Court. After both sides’ best academic experts pled their cases, the Supreme Court decided to strike down the law, arguing in favor of First Amendment rights, with video games—violent or otherwise—falling in the category of free speech.

Gield seems to see value in this decision, feeling that current research by social scientists is not sufficiently solid to give clinicians, notably pediatricians, clear direction on what to recommend to families of children attracted to violent media.

So where does this leave us today? I believe the findings of the Commission and Gield’s article are excellent jumping-off points to place my own views on violent media in a broader cultural context.

Though I am a clinician, my perspective is not simply based on clinical anecdotes, but neither is it rooted solely in my reading of the researchers. Rather, I anchor my perspective in a reading of American social history. As a cultural historian, I often find it prudent to place scientific studies of this nature in a historical perspective, since children sitting in front of TV sets hardly live in a cultural vacuum.

Over the last 60 years, the American family has gradually evolved. In particular, three cultural trends impacting American families are readily evident: high divorce rates, births of fewer children, and greater family mobility. The first two changes mean there are fewer family members now living in most households; the third translates into greater physical distances separating nuclear and extended families.

Three additional cultural trends deserve mention as well: the departure of both parents into the workplace, the stagnation of wages in many families, and the general perception that many neighborhoods are unsafe. These trends signify longer hours for parents away from home, while their children are left indoors, often unsupervised and alone.

A final factor is the gradual penetration of the media into the average home. Between the 1950s and our time, the sheer number of media gadgets deployed in households has grown exponentially. They sit installed in living and dining rooms, bedrooms, and kitchens. They drone on as we eat, attempt to speak over them, and fall asleep. In short, they are everywhere.

Unsurprisingly, these seven cultural trends begin to work in tandem. As a child’s contact with adults and other children dwindles, the child wanders more readily toward the media. While the voices of parents, siblings, and extended families grow less influential, and media imagery more ubiquitous, media creations have become our children’s mechanical companions and playmates. Because of the sheer volume of media violence bombarding our kids, this artificial brutality becomes imbedded in their minds. With this repetitive imagery buried deep in our children’s memory, in their dreams day and night, isn’t it likely to spring from fantasy into reality, one way or another?

George Drinka, M.D. is on the clinical faculty of the Oregon Health Sciences University.

;)

Abby

5 Things Your Child Should Know About Gay Marriage by Christia Spears Brown, Ph.D.

This week, President Obama mentioned gay marriage in his inaugural speech. He stated, “[o]ur journey is not complete until our gay brothers and sisters are treated like anyone else under the law—for if we are truly created equal, then surely the love we commit to one another must be equal as well.”  Lots of children watched the speech, more so this year than usual because it fell on a school holiday. Earlier in the week, NBC Nightly News covered a story about marriage equality laws in the US. Children, particularly children in elementary school and older, are listening to these snippets of the gay marriage debate. Even if you don't talk about the topic at the dinner table, your kids likely know more about it than most parents assume.

After hearing the news coverage the other night, my own 8-year-old mentioned that gay people shouldn't marry because they can't reproduce. I was taken aback, not knowing where she picked this up – and realizing she was taking the exact opposite position I would have taught. She heard this somewhere, I am not she even really understand the concept of reproduction. She was saying a sound bite. With her still-developing brain, she struggles to understand an abstract political concept. Even when kids know someone who is gay or lesbian, they may not understand how a political issue relates to real people.

Based on a national Gallup poll from November 2012, more people support marriage equality than oppose it. But even if you support it, you may not know how to talk to your kids about it. It is such a heated debate in the US that it can feel a little like tiptoeing around a landmine. I know I didn't really want to delve into a conversation about reproduction. I did tell her that lots of couples can't reproduce (we have lots of friends who used adoption) and lots of married couples don't have children. But it made me realize that a lot of other kids probably heard these same snippets and the debate provides a teachable moment. Here are the top 5 things elementary school children should know about gay marriage, and how to tell them in ways they can understand. 

1. They probably already know kids at school with two moms or two dads. For children, they need concrete concepts. They can't really grasp the concept of a state-based constitutional amendment. What they do know is being a kid. In the US, at least two million children are being raised by gay or lesbian parents. So the odds are, even if they don't know it, they probably have a kid or two or ten at their school with two moms or two dads. The debate in the country is happening and will continue to happen for a while. Regardless of whether you agree or disagree with marriage equality, the reality is it affects real kids in real families, and those real kids live just down the street. At my house, after my daughter made the disparaging comment, I realized she didn't know that this affected real people, real kids, real friends. We promptly went to my Facebook profile and looked at pictures of my gay and lesbian friends in very real and committed partnerships and families. It wasn't just a news story, it is real life.  

2. Two-mom families and two-dad families work just like any other family. One or both parents work, kids have chores, kids play and fight and get into trouble, and families sit down for dinner and talk about their day. A new study in Child Development shows that lesbian parents do the best at sharing parenting responsibilities, and their kids benefit from it. Although these families may look different than your family, all families differ in lots of ways. Some families have one parent, some two parents, some a grandma, some a foster mom. All families are different and all families are the same. As we say in my house, "The only rule for families is you have to love one another. All the other stuff is details."    

3. The worse part of having two moms or two dads is the teasing that can happen. Kids can be teased by other kids at school for being different. Kids get teased for lots of different reasons – wearing the wrong sneakers, speaking with an accent, being a slow reader. And having two moms or two dads isn't really different than this. Teasing by others, though, is harmful. Kids who are teased by their peers, especially if it is consistent, are more likely to be depressed, anxious, and have trouble concentrating in school. It is also hurtful for kids with two moms or two dads to see their family described as "not normal." Kids in elementary school understand discrimination, especially when it affects their family. The negative consequences of experiencing discrimination – whether it be by other kids, other parents, teachers, or the government – impacts children in deep, meaningful ways. This is bad for kids, regardless of your politics.  

4. Sometimes adults can be wrong, and hurtful. Kids typically assume if an adult says it, it is true, fair, and final. As adults, we know this isn't the case. But kids can also understand that ideas change over time. They have learned about the civil right movement and Martin Luther King. They understand that, at some point in history, people thought Blacks and Whites shouldn't go to school together. They understand that people's ideas have changed over time to be more fair. People's ideas about this will also change.      

5. If they notice bullying, they should say something to an adult who can stop it. Period. No kid should be made fun of for any reason. Just because parents have strong opinions, and they may see adults express their opinions forcibly, no kid should be the target.

Christia Spears Brown, Ph.D., is an Associate Professor of Developmental Psychologist at the University of Kentucky. She earned her doctorate at The University of Texas at Austin and was previously a professor at UCLA. She is fascinated, and perplexed, by parents' obsession with looking for gender differences in their children. Her work on the impact of gender stereotypes on children and adolescents has been published widely in top scientific journals and featured in numerous newspapers, magazines, local radio shows, NPR, and CBS Evening News. Her book, in which she uses research, with common sense and a healthy dose of patience, to raise her own daughters, is currently available: Parenting Beyond Pink and Blue: Raising Kids Free of Gender Stereotypes (Ten Speed Press). 

;)

Abby

Decisions Teens Make: Naughty or Nice?

With many kids gearing up for a holiday at home, their parents may soon be wrestling with the question of the season, “naughty or nice?” In making the calculation about their teenager’s behavior, it’s a good question and a fair point. The answer lies in the fact that much of what adolescents think and do, by developmental design, walks the line between naughty and nice … or at least normal.

What does that mean?

At a time of breathtaking physical and psychosocial development, teens are charged with accomplishing three critical tasks: establishing an identity of their own; becoming more independent from their parents; and forging more adult-like relationships with peers. In the aggregate, their progress on these tasks forms a young person’s sense of self, a harbinger of decision-making, confidence and overall mental health.

According to Teens Today research conducted by SADD (Students Against Destructive Decisions), high Sense of Self (SOS) teens are more likely to avoid alcohol and drug use, while low Sense of Self teens are more likely to use alcohol and "harder" drugs such as ecstasy and cocaine. In addition, high SOS teens are more likely than their low SOS counterparts to report feeling smart, successful, responsible and confident. On the mental health side of the ledger, low SOS teens are more likely than high SOS teens to report regular feelings of stress and depression.

Significantly, there is a parental overlay that offers guidance for moms and dads everywhere. For example, 62 percent of teens with a high SOS report that their relationships with their parents make them feel good about themselves, while only about one-third of low SOS teens report the same. In addition, teens with a high SOS report overwhelmingly that they feel respected by their parents (93 percent) and close to their parents (85 percent), while teens with a low SOS report significantly different levels of respect (8 percent) and closeness (12 percent).

In other words, parents have skin in the game!

Understanding the relationship between each developmental task and behavior likely to accompany it is important, as is supporting the progress of our teens on their developmental journey.

Identity: As young people seek to answer the question “Who am I?,” they regularly – and sometimes frequently – try on different roles, which in turn changes their behavior and may make them appear to be “strangers” on any given day.

Independence: A drive toward independence dictates that our teens push us away, or at least hold us at arm’s length. Paradoxically, they need us more now than at any other time during the lifespan besides early infancy.

Peer Relationships: The peer group is paramount, and teens often filter through it what they hear from us. Even so, we are the number one reason our teens make good choices.

Parents can help their teens achieve a high Sense of Self by:

• Supporting a wide sampling of interests, activities and age-appropriate behaviors;

• Encouraging separation from parents and age-appropriate independence in decision-making;

• Teaching peer-to-peer social skills and facilitating (positive) peer relationships;

• Focusing on productive parent-teen communication.

Perhaps most important, we can remind each other that, in many ways – and within limits – our adolescents are doing what they are supposed to be doing. In the end, they’re likely a healthy mix of naughty and nice.

Love,

Abby

Smiles of a Sumatra Night

Presents evidence delineating just how much nature shapes our emotional reactions. Studies on Americans' expressions of anger; Studies on the Minangkabau, a matrilineal, Moslem agrarian culture; Physiological changes; Physiological responses to emotions; Common ties of humanity.

In the longest-running debate on human behavior, nature and nurture have been duking it out for over a century, with nature getting an awful lot of decisions in the past decade or two. Now comes evidence delineating just how much nature shapes our emotional reactions.

When Americans create the expressions associated with anger and fear, the autonomic nervous system swings into gear and puts the body on alert, raising heart rate and altering skin temperature. To determine whether these changes are specific to Americans, and thus learned, or are part of a common inheritance, Robert Levenson, Ph.D., of Berkeley, and Paul Ekman, Ph.D., of San Francisco, headed off to West Sumatra. There they looked at people as different from us as you can get: the Minangkabau, a matrilineal, Moslem, agrarian culture that discourages displays of negative emotion.

Yet, when the Minangkabau were taught facial muscle contraction in order to mimic angry or fearful expressions, they registered the same physiologic changes - though they didn't feel the same way. No matter how different we seem, deep down we're all alike, observes the team in the Journal of Personality and Social Psychology (Vol. 62, No. 6).

But if biological events turn out to be the same, subjective emotional experience is altogether different. "In our culture, we focus on the physiological sensations that happen when we feel emotions. This is in fact one of the most important aspects of emotion for us," reports Levenson. Ask an American what anger is and he'll tell you what he physically experiences when he is angry. But the Minangkabau didn't feel any emotions when they made the negative facial expressions.

"In their culture, the people are more entwined. Emotions define their relationships, not bodily sensations," explains Levenson. To them, anger is when a friend is mad at you, not how your body responds.

"Physiological responses to emotions are hard-wired into us; they're common for all people," says Levenson. "But what we do with that information is culturally variable."

published on January 01, 199

Love,

Abby

Sexy 7-Year Olds? by George Drinka, M.D.

With the media joining our families ever more intimately, it has become a common source of children’s sexual education. But how early should this education begin? Age 12? 11? 10? And how explicitly? In a recent article, we learn about a mother’s dilemma over a music video on YouTube whose lyrics go: “I got passion in my pants, and I ain’t afraid to show it, show it; I’m sexy and I know it.” The mom’s younger sister shows it to her children: a girl aged 7, and a boy, 10. The sister thinks this video is funny, not educational at all, and the kids laugh along—it’s only their mother who thinks it’s not funny.

The mother watches the video as a singer in the rock group shimmies around in a gold lace G-string, belting out the dicey lyrics. Fuming and flummoxed, she explores the Internet to discover that the world around her is crazy over this song: hundreds of YouTube videos feature kids under 10 dancing to these lyrics, while their parents record their gyrations and giggle behind their cameras.

Still, she is concerned this isn’t funny and way too suggestive. How to respond? First, she considers banning the song from her home but quickly anticipates that her kids will get upset with her, and they will only end up quarreling. Besides, they’ll find the video all the more enticing and go look for it elsewhere. Her next thought is to speak openly with her kids about its sexual content. But this tactic elicits blank stares, and, feeling embarrassed, she hesitates. At last, she gives up, deciding to ignore the incident and move on, but she’s still perplexed by the issue. What’s the right thing to do?

Perplexed myself, I too researched YouTube. On one site, I discovered the band performing on stage in underpants, with silly tongues protruding from comic mouths on their crotches. In another, a paunchy young man cavorts in underwear, sporting what seems a hard-on. In others, kids dance to the tune as their amused parents record it all. In one a baby in diapers rocks and rolls—I wondered, do diapers give a different meaning to “passion in my pants”? In still others, teen girls pantomime the hit in their bedrooms. In a pathetic rendition, very obese adults wriggle their flab and make light of the “sexy and I know it” lyric, as well as the later-appearing line, “I work out.”

In another twist, well-known animated figures dance and mouth the lyrics: Alvin and the Chipmunks, Homer Simpson, Peter from Family Guy, Sonic the Hedgehog, a few Sesame Street characters, and others. Now I could see more clearly why the mother was so confused: to the whole world, the song is a joke.

Slowly I perceived that humor was the central point. To the two kids, the image seemed goofy, silly, the stuff of comedy. When Peter in Family Guy does his thing to the lyrics, and Homer Simpson, drinking beer in underpants, lunges his torso, while SpongeBob Squarepants joins in with a few of his pals, and all the other comic figures thrust their pelvises to the beat, they elicit giggles and mirth. But is sex that humorous?

Laughter disarms us, but it also desensitizes us to the words: here sexual exhibitionism becomes a laugh. The daughter is only 7, and she’s learning about sex—only now, it’s funny. Since the mom doesn’t want to be a prude, she drops it, but her kids are imbedding sexually explicit words and gestures in their memory banks, even if they’re not sure what they’re saying or enacting.

George Drinka, M.D. is on the clinical faculty of the Oregon Health Sciences University.


Love,
Abby

Video Game Violence: Does Player's Personality Matter More Than the Game?

*Lisa has found that the online gaming community has given her a way to fit in despite the violence in some of the games. "Gamers have their own social networks, you know.Whether it's chat-room role-playing, Xbox LIVE or meeting for group D&D - it brings a whole new group of people into your life that you might know only tangentially." Lisa, like many teens, appreciates the online socialization factor as much as she does the video games – and she's not alone. A recent survey conducted by Pew Internet & American Life Project found that a whopping 99 percent of teenage boys and 94 percent of girls play video games on a regular basis.

If you're the parent of a teenager, then you probably already know about some of the hottest video games on the market and the time your teen spends playing them. Today's games are far cry from the archaic graphics of the Atari generation's Pitfall and Space Invaders. Video games today are highly interactive making them more fun, thrilling, and addictive than ever. The downside? Instead of running the risk of being eaten by alligators as you swing through the digital jungle, you may be blown up into a thousand pieces, decapitated, or brutally stabbed to death. The violence in today's gaming is bigger, badder, and more prevalent than ever before and so are the number of teens playing them.

For years, there has been an ongoing debate between parents and the media about the level of violence teens are exposed to in video games. Hot games like Call of Duty, Grand Theft Auto VI, Halo, and Dead Space were all ranked by by PC Magazine in the top ten most most violent video games of all time. Chances are your teen either owns one or has played one of them before. But if you are worried that these games will turn your son or daughter into an homicidal maniac, then you can take refuge in the latest research that says it's not about the violence as much as it is about the player's personality traits.

The study published in the journal Review of General Psychology found an increased hostility in teens with certain personality traits such as those with low tolerance for agreeableness and conscientiousness and with extremely high neurotic tendencies. The researchers also found that it was not the violence in the video game that perpetuated violent behavior in some teens, but rather how their personalities tolerated and integrated the violent content of the video games. Interestingly, it was the competition in the games that had the most influence on aggression as opposed to the violent content. It's important to note that even with the latest findings, the potential risk still exists for some teens to become violent if their personality characteristics cannot integrate and process the 'competition' of the game in a healthy manner. However, the good news is that the study suggests a smaller percentage of teens may be effected than previously thought.

As gaming grows in popularity so does the debate over the impact of violence in video games on our youth. While this study certainly sheds light on how teens integrate violence into their personalities, there are other studies that dispute this finding. The bottom line? Most of us would agree that games like Grand Theft Auto IV isn't meant for young children and there aren't many parents who would support allowing their teen to play a game that involves assaulting a police officer. However, parents now have many tools and tactics at their disposal from software to websites to help cope with their teens taste in video drama. Trying to limit the amount of time and the content of what your teen plays can be difficult, but is well worth the vigilance. Likewise, talking with your teen about the violent content is also helpful regardless of how many times he smirks and rolls his eyes.

As disturbing as the extremely violent content in today's video games is, it reflects only a small part of a much larger social problem. We are a culture that breeds violence in all forms of the entertainment media – a fact that unfortunately won't go away any time soon.

Study says it's not about the video game, it's about the player. 

Love,

Abby