Toddlers and stochastic parrots

For The New Yorker, Angie Wang draws parallels between toddler learning behavior and training large language models, but more importantly, where they diverge.

They are the least useful, the least creative, and the least likely to pass a bar exam. They fall far below the median human standard
that machines are meant to achieve.

They are so much less than a machine, and yet it’s clear to any of us that they’re so much more than a machine.

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Protecting Children Where They Learn, Play During Disaster Recovery

building inspector

Emergencies, including natural disasters like earthquakes and hurricanes, can happen at any time. They can have lasting impacts on communities.recovery supplement Places that were once safe might become unsafe. Homes, businesses, childcare facilities, schools, and other buildings can be damaged or destroyed.

After the initial response, communities begin a long recovery process. Buildings are rebuilt, infrastructure is repaired, and there is the appearance of recovery. What often goes overlooked is the need for recovery guidance that promotes environmental safety and prevents exposure to hazards.

A major concern in the aftermath of natural disasters is the safety of children. Children are at higher risk from environmental hazards because of their physical, developmental, and behavioral differences from adults. Environmental exposures, such as drinking contaminated water, can cause diseases and disrupt children’s development, learning, and behavior.

What is the Agency for Toxic Substances and Disease Registry doing to help with disaster recovery?

The Agency for Toxic Substances and Disease Registry (ATSDR) recognizes the importance of preparing to protect children from harmful exposures during disaster recovery. We also know that planning for these efforts can be a challenge.

ATSDR’s Choose Safe Places for Early Care and Education (CSPECE) Disaster Recovery Supplement helps public and environmental health professionals reduce children’s environmental exposures where they learn and play. With this tool, professionals are better prepared to

  • identify potential hazards.
  • compile resources needed to address environmental hazards, such as flooding, that can affect locations where children spend time.
  • establish ways to reduce risk and help community members, particularly children, feel secure as they recover and return to pre-disaster routines.

Disaster Recovery Supplement in Action: Puerto Rico

From December 2019 through early 2020, the southwestern region of Puerto Rico experienced an earthquake swarm. It included 11 quakes that were magnitude five or greater.

Before this disaster, the staff members of Head Start, a federal government-sponsored early child care program, attended a training hosted by the Puerto Rico Department of Health (PR DOH) on the new Post-Disaster Self-Assessment Form (PDSAF).

The PDSAF provides resources for childcare facilities in case hazards are discovered. It also provides suggestions on how childcare staff can protect children from environmental hazards during the recovery process.

In response to the earthquakes, Head Start asked that PR DOH use the PDSAF to assess major health hazards that might prevent them from safely reopening facilities. PR DOH visited several Head Start program sites to conduct assessments using the PDSAF tool. They found that many Head Start facilities had cracks in the walls. Some facilities also had cracks in the supporting structures.

Through the PDSAF, it was clear that professional engineers should inspect the Head Start buildings before allowing children back inside. Officials conducted daily site evaluations to determine if they were fit to open while earthquakes and aftershocks continued to occur.

After a disaster, such as an earthquake, the environment and surrounding communities can change drastically. Some of these changes can lead to the migration of harmful substances, such as lead-contaminated debris from damaged buildings, which can cause environmental hazards that were not present previously. Changes like these can complicate decisions about whether it is safe to reopen an early care and education facility after a disaster.

The PDSAF is a useful tool in environmental recovery efforts. It helped Head Start and PR DOH determine whether it was safe to reopen facilities and programs after the disaster.

Returning to pre-disaster routines, such as attending school or childcare, is important to a community’s sense of well-being and disaster resiliency. With proper recovery guidance, we can prepare our communities for environmentally safe recovery.

Learn more about the CSPECE Disaster Recovery Supplement.

Thanks in advance for your questions and comments on this Public Health Matters post. Please note that 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 (http://www.cdc.gov/cdc-info/index.html) 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.

Delaying motherhood

The New York Times mapped birth rates, which are down almost everywhere, especially among women in their 20s:

The result has been the slowest growth of the American population since the 1930s, and a profound change in American motherhood. Women under 30 have become much less likely to have children. Since 2007, the birthrate for women in their 20s has fallen by 28 percent, and the biggest recent declines have been among unmarried women. The only age groups in which birthrates rose over that period were women in their 30s and 40s — but even those began to decline over the past three years.

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Schedule change with a baby

It’s difficult to emphasize how much life changes when a child comes into the picture. Caitlin Hudon made a chart to show how her daily schedule shifted dramatically.

For a while, it seems like all of your free time is gone for good, but ever so slowly, you get a little bit of it back as they grow more independent.

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Deaths from child abuse, a starting dataset

By way of the Child Abuse Prevention and Treatment Act, ProPublica and The Boston Globe requested records from each state. They compiled the many documents into a single dataset:

In each record, CAPTA requires states to list the age and gender of the child, and information about a household’s prior contact with welfare services. The information is supposed to help government agencies prevent child abuse, neglect and death, but reporting across states is so inconsistent that comparisons and trends are impossible to identify. ProPublica is releasing the data we’ve collected as a minimum count of child fatality records in the United States. Researchers and journalists can download the full records with summaries at the ProPublica Data Store.

Unfortunately, not all state agencies are compliant, but it’s a start.

Also, Jessica Huseman of ProPublica discussed some of the emotional challenges of working with such sensitive data.

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Protecting Our Future: Emergency Preparedness and Children’s Mental Health

Sad boy sitting against a brick wall with his face hidden

Among the many lessons learned during the 2017 Hurricane season, we recognized that addressing children’s mental and behavioral health needs is a major concern in hurricane-affected areas.

CDC’s At Risk Task Force (ARTF) was established in 2017 to ensure identification and prioritization of the mental and physical health needs of at-risk populations, including children. ARTF’s first Emergency Operations Center (EOC) activation was on Aug. 31, 2017, in response to Hurricane Harvey, the first of three consecutive hurricanes to hit the United States and its territories in a five-week period. ARTF’s mission was to address the needs of at-risk populations in affected areas throughout the response and recovery phases.

Early in the response, it became clear that the emotional impact of the storms and the mental health needs of people, particularly children, affected were a critical area of focus. ARTF worked closely with federal and non-government agencies to address these needs so that children and families had the best chance for recovery.

October 10 is World Mental Health Day. The theme this year is Young People and Mental Health in a Changing World. In light of this, we want to share our experiences to inform mental health interventions and improve outcomes for children after public health emergencies and natural disasters. First, let’s talk about what makes children more vulnerable in emergencies.

Why are children more vulnerable in emergencies?

Mental stress from a disaster can be harder on children. Children are more vulnerable in emergencies: Because they breathe in more air for their size than adults, children absorb harmful materials from the air more readily. Because they spend more time outside, are lower to the ground, and put their hands in their mouths more often than do adults. Because they may not be able to communicate their symptoms or feelings. Because they need medicines, and specifically designed equipment for emergency situations that are different from adults.Children are more vulnerable in emergencies because of their physical, developmental, behavioral, and emotional differences from adults. Children may have difficulty or may not be able to communicate symptoms or feelings. They may understand less about the situation and feel less able to control the events around them.

The aftermath of an emergency or disaster is also difficult for children because they have less experience coping with difficult situations.

The emotional impact of an emergency depends on a child’s characteristics and experiences, the social and economic circumstances of the family and their community, and the availability of local resources. Other factors may influence the emotional impact on children, causing them to be more vulnerable in emergencies. These include children with mental, behavioral, or developmental disorders. Children who have experienced trauma in the past may also have more difficulty coping with a disaster.  

What does the At Risk Task Force do for children’s mental health during a hurricane response?

During the 2017 hurricane season, the ARTF collaborated with federal and non-government partners to monitor behavioral health in affected areas and disseminate key messages and coping resources for children in schools and vulnerable populations in other contexts. ARTF coordinated a webinar for primary care physicians that focused on identification of common adjustment difficulties in children, provided strategies to promote effective coping skills in children and their parents, and explained the importance of self-care for professionals. The webinar was attended by more than 300 clinicians and other health care providers on Oct 26, 2017.

Public health professionals also play an important role in addressing short-term and enduring mental health needs of the population. Timely and accurate mental and behavioral health surveillance data, that includes specific information on children, could inform intervention efforts to improve developmental outcomes for children in the longer-term aftermath of disasters. It is important that mental health surveillance be incorporated into preparedness planning so that surveillance systems can be established or leveraged immediately when emergency response begins.

What are next steps for CDC?

Children’s mental health needs are a prominent concern in hurricane-Recommendations to help children cope during and after an emergency: • Share age-appropriate information • Encourage children to ask questions • Limit media exposure • Return to a routine • Reunite children with caregivers as soon as possibleaffected areas. There is still a gap in real-time information on mental health needs to inform intervention efforts and improve child outcomes. CDC is working internally to enhance efforts to monitor health impacts during and after natural disasters, including integrating mental health into standard data collection.

CDC is also working with partners to integrate children’s mental health in preparedness planning. Following the 2017 hurricane season, CDC collaborated with the American Academy of Pediatrics to develop an activity book for children and families, Coping after a Disaster, that focuses on feelings children might have after a disaster and coping strategies that may help. This book is part of a series that follows Ready Wrigley, a dog who helps her family prepare for emergencies and their impacts.

CDC is now partnering with the National Hazard Center to develop mental and behavioral health training modules for researchers conducting field research immediately following an extreme event, such as a hurricane. These free, online trainings will provide background information on mental health in the context of disasters, as well as a list of mental health assessment tools used following a disaster for various vulnerable populations (e.g., children, older adults). The trainings and associated resources will address current research gaps in mental health, help to organize research in this area, and share best practices with researchers.

On Sept. 12, 2018, CDC activated the EOC to respond to Hurricane Florence, which made landfall off the coast of North Carolina on Sept. 13. The ARTF was quickly activated to address the needs of vulnerable populations. As the storm decreased in intensity, North Carolina began reporting increased emergency department visits related to stress and anxiety. Mental health concerns in children, similar to 2017, are expected to remain a prominent focus throughout the response and recovery phases. The ARTF continues to monitor the situation and support the mental and behavioral health needs of children and vulnerable populations in affected areas.

Additional Resources:

Mapping opportunity for children, based on where they grew up

Opportunity Atlas, a collaboration between Opportunity Insights and the Census Bureau, is the product of ongoing research on the demographics of people, based on the neighborhood they grew up in.

The Opportunity Atlas provides data on children’s outcomes in adulthood for every Census tract in the United States through an interactive map providing detailed research on the roots of these outcomes, such as poverty and incarceration rate, back to the neighborhoods in which children grew up. This tool will enable policy makers, practitioners, and the public the unprecedented ability to look within their city to understand better where opportunity exists and how each neighborhood shapes a child’s future economic and educational success.

The map application was developed by Darkhorse Analytics. Zoom in to an area of interest, subset on demographics such as income level, race, and gender, and see how the people who grew up in those areas fared later in life. You can also download the tract-level data to look for yourself.

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After the Storm: Helping Kids Cope

A boy and his mother wait to cross the street on their way to school.

Changing schools is hard for any kid. Imagine picking up without any notice and moving to a new school in a brand new place with a different climate, culture, and maybe even a different primary language.  Harder still is the thought of moving because your home and community have been devastated by a major hurricane. The truth is, this is the reality for the tens of thousands of students from Puerto Rico and the U.S. Virgin Islands (USVI) who moved to the continental U.S. after Hurricane Irma and Hurricane Maria.

Recognizing a need

As a Massachusetts native, I subscribe to news alerts from the Boston area. One morning before heading to work in CDC’s Joint Information Center, I saw a news article about the influx of PuertoCDC's Joint Information Center (JIC): The JIC Outreach Team is responsible for reaching hard-to-reach and at-risk audiences with important health and safety information during and after a public health emergency. Rican children displaced by the hurricanes who were relocating to the cities of Springfield and Holyoke in western Massachusetts.  Both cities have large Puerto Rican populations, and many residents were taking in relatives and friends from the devastated island. Schools in the territories would be closed for months after the storm, so many families were coming to the continental U.S. so their kids could keep going to school.

Children who were displaced as a result of the hurricanes faced the challenges of leaving behind their homes, communities, and schools, family and friends, and even their pets.  Kids in middle and high school were old enough to understand the uncertainty facing their families. They had to stay strong to support their parents and siblings, while finding a routine at a new school and keeping up with their academics.

Understanding the issue

During my meeting with the Hurricane Emergency Response Communication Teams, I brought up the article I had read that morning. Dr. Melissa Mercado-Crespo, a behavioral health scientist at CDC’s National Center for Injury Prevention and Control, took a special interest in the well-being of the families who had been displaced by the hurricanes. Dr. Mercado serves on the StopBullying.gov Editorial Board, and grew up in Puerto Rico. Most of her family and loved ones still live there, and when the storms hit, her husband was deployed to the island with the U.S. Army Reserves.

In collaboration with the CDC At-Risk Task Force, Dr. Mercado and I reached out to federal and local partners to find out how many hurricane-displaced students from Puerto Rico and USVI had enrolled in the middle of the semester. Through media and local sources, we learned that most of the students had enrolled at schools in Florida and New York, as well as cities in western Massachusetts. The Center for Puerto Rican Studies at Hunter College, City University of New York, confirmed our findings. They estimated that after September 20, 2017 – the day Hurricane Maria hit Puerto Rico – 10,324 Puerto Rican students enrolled in Florida schools. The Puerto Rico Department of Education reported that nearly 25,000 students have left the island and are no longer enrolled in the Puerto Rico public school system.

Taking action

My former colleagues in Boston put me in touch with José Claudio of the New North Citizens’ Council, a community organization that provides public and human services to residents in the Springfield area. He mentioned that many of the students were struggling to adapt to their new setting and that there were misunderstandings between the permanent students and their new peers. We wanted to provide teachers and youth organizations with tools and resources that could help make the transition easier for everyone.

To help address these challenges, we pulled together a list of resources to help teachers and youth organization leaders plan activities to prevent and reduce the emotional challenges new students may face and help them cope with the trauma following hurricanes. We published the list in a Spotlight issue of the CDC Emergency Partners Newsletter that was reviewed by CDC behavioral health experts and representatives from StopBullying.gov, SAMHSA, and the National Child Traumatic Stress Network (NCTSN). The newsletter went out to partners, and we received positive feedback from teachers, school counselors, and organizations that serve Hispanic populations in the U.S.

The messaging needs and target audiences change before, during, and after every emergency. We identified a new target audience during the 2017 Hurricane Response – children from Puerto Rico and USVI who left their schools and homes behind after the storms. Our hope is this is the first step in concrete efforts to help ensure they are no longer left behind.

Learn more

Subscribe! CDC Emergency Partners Newsletter

6 Things You Need to Know About This Flu Season

Sick boy lying in bed having his temperature taken with a thermometer.

Seasonal flu activity has been intense this season.  As of February 16, 2018 most of the United States continues to experience intense and widespread flu activity, with record-breaking levels of influenza-like-illness and hospitalization rates recorded. While H3N2 viruses are still most common, there is an increasing number of influenza B viruses being detected. It’s not uncommon for second waves of B virus activity to occur during a flu season. It’s likely that flu activity will continue for several more weeks.

Here are some important things to know right now to protect yourself and your loved ones from flu:

1.  What are the symptoms of flu?

Flu viruses can cause mild to severe illness, and at times can lead to death. The flu is different from a cold. The flu usually comes onIf you have the emergency warning signs of flu sickness, you should go to the emergency room. These include: In children • Fast breathing or trouble breathing • Bluish skin color • Not drinking enough fluids • Not waking up or not interacting • Being so irritable that the child does not want to be held • Flu-like symptoms improve but then return with fever and worse cough • Fever with a rash; In addition to the signs above, get medical help right away for any infant who has any of these signs: • Being unable to eat • Has trouble breathing • Has no tears when crying • Significantly fewer wet diapers than normal; In adults • Difficulty breathing or shortness of breath • Pain or pressure in the chest or abdomen • Sudden dizziness • Confusion • Severe or persistent vomiting • Flu-like symptoms that improve but then return with fever and worse cough. suddenly. People who have the flu often feel some or all of these symptoms:

  • Fever* or feeling feverish/chills
  • Cough
  • Sore throat
  • Runny or stuffy nose
  • Muscle or body aches
  • Headaches
  • Fatigue (tiredness)
  • Some people may have vomiting and diarrhea, though this is more common in children than adults

* It’s important to note that not everyone with flu will have a fever.

2.  What do I do if I get sick?

Most people with the flu have mild illness and do not need medical care or antiviral drugs. If you get flu symptoms, in most cases you should stay home and avoid contact with other people, except to get medical care.

CDC recommends that antiviral drugs be used early to treat people who are very sick with the flu (for example, people who are in the hospital) and people who are sick with the flu and are at high risk of serious flu complications, either because of their age or because they have a high risk medical condition.

3. Is it too late to get a flu shot?

No!  As long as flu viruses are still circulating, it is not too late to get a flu shot.  Flu vaccination is the best way to prevent flu illness and serious flu complications, including those that can result in hospitalization. Unfortunately, flu vaccines don’t work as well against H3N2 viruses, which means that some people who got vaccinated will still get sick; however, there are some data to suggest that flu vaccination may make illness milder. Flu vaccines usually work better against H1N1 viruses, which is another good reason to get vaccinated, since H1N1 is circulating too.

4.  Why should I get a flu shot?

In addition to protecting yourself, getting vaccinated also protects people around you, including people who are more vulnerable to serious flu illness, like babies and young children, older people, pregnant women and people with certain chronic health conditions.

5.  Does the flu shot work?

Vaccine effectiveness data for this season are not available yet, but we know that flu vaccines do not work as well against H3N2 viruses, which are predominant so far this season.

6.  What else can I do to protect myself from flu?

Definitely try to avoid close contact with sick people.  If you do get sick, limit contact with others as much as possible to keep from infecting them. Stay home for at least 24 hours after your fever is gone without the use of fever-reducing drugs (unless you need medical care or other necessities).

Other tips for stopping the spread of germs:

  • Make sure you cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
  • Wash your hands often with soap and water.
  • Avoid touching your eyes, nose, and mouth. Germs spread this way!
  • Clean and disinfect surfaces and objects that may be contaminated with germs like the flu.

Educating Children After Hurricane Maria

In September 2017, Hurricanes Irma and Maria roared through the Caribbean just 12 days apart. The schools on St. Croix and St. Thomas in the U.S. Virgin Islands (USVI) did not re-open until October 24. Teachers talked about how many of the books and materials in their classrooms were moldy and how teachers and staff had to help the janitorial staff clean up classrooms. Parents shared stories of their children coming home from school with mosquito bites all over their arms and legs. Schools could not always run the air-conditioning because they were operating using generators.

Finding a natural fit

As a team lead in the Division of Adolescent and School Health, I have expertise in how health departments and federal agencies should work with schools. So when I was deployed to support health communication activities in the US Virgin Islands after Hurricane Maria, I offered to support the USVI Department of Health doing health communication outreach to schools. We worked quickly to connect with schools and distribute materials to students and their families about how to stay safe and healthy after a hurricane.

Making a vision a realityChildren are the key to primary prevention because they are the drivers of the health behaviors we hope to change. -Malaika Washington

I worked with Director of Public Relations, Nykole Tyson, at the USVI Department of Health and the USVI Department of Education to determine how many children were enrolled on St. Croix, St. Thomas, and St. John and which educational materials from CDC to distribute. With support from the CDC Foundation, we printed and distributed flyer packets for over 16,000 K-12 students on the three islands to take home to their families. The packets contained CDC-developed materials about how to stay safe after a hurricane, including tips for food and water safety, how to prevent mosquito bites, the health risks from mold, how to avoid carbon monoxide poisoning, and mental health. Since 35% of the children on St. Croix speak Spanish, we made the messages available in both English and Spanish.

Each child was also given a copy of the Ready Wrigley Flooding and Mold Activity Book as part of the flyer packet. Ready Wrigley is a series of CDC-developed activity books for children 5-9 years old and their families to help them talk about and prepare for emergencies. There are nine Ready Wrigley books that provide tips, activities and a story about disaster preparedness. The flooding and mold activity book talks specifically about safe mold clean-up after a flood and how kids should never touch mold and always tell a grown-up if they see mold.

Giving children a voice

Malaika Washington reading the Ready Wrigley Flooding and Mold activity book to students in USVI.
Sharing the Ready Wrigley Flooding and Mold activity book with students in USVI.

American Education Week takes place every November. The USVI Department of Education contacted Director Tyson and asked her to read to elementary school students on St. Croix. She asked me if I would like to join her visits to kindergarten and first grade classrooms. I jumped at the chance to interact with students in-person and suggested we read the Ready Wrigley Flooding and Mold Activity Book. I even colored the pictures in the book and completed the activities so the children could follow along. We shared the Ready Wrigley books with the teachers at each school we visited, giving teachers enough copies of the book for every student to take one home.

All of the students really wanted their stories heard. One first grader recounted how his mother and grandparents told him to stay far away from the cleaning products while they cleaned up the mold in their home. Another little girl shared how she was personally impacted by mold. She had to sleep on the sofa in her home because there was mold all over her bed and the other furniture in her bedroom. Several other children described the mold they found on the front door of their homes after the hurricane.

Fulfilling a passion

Working with school-aged children is so rewarding. This deployment experience was the best I could have hoped for. The time I spent in the USVI made me realize my personal and professional goal to provide public health education materials to children and their families. I have always believed that public health prevention work should begin with school-aged youth and it is my lifelong public health mission to ensure that they have a voice.

Malaika Washington has been a Commissioned Corps Officer in the United Stated Public Health Service since October 2009. She is a team lead in the Division of Adolescent and School Health, the only division at CDC that funds education agencies directly. Her deployment to the U.S. Virgin Islands for the 2017 HHS Hurricane Response was the first time she deployed for a public health emergency.