pediatrics

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Yes, We’re Mammals, But Is It Wise These Days To Promote Breast-Feeding As ‘Natural’?

Public health officials should think twice about the unintended consequences of calling breast-feeding 'natural,' the authors of a new paper argue. (Michael Sawyer/AP)

Public health officials should think twice about the unintended consequences of calling breast-feeding ‘natural,’ the authors of a new paper argue. (Michael Sawyer/AP)

Hippos do it. So do orangutans. There’s no question that for us mammals, nursing is one of those defining behaviors in nature. The question is whether public health officials, in promoting breast-feeding among human mothers, should deploy the term “natural.”

Two academics pondering these and other linguistically charged questions sparked an online frenzy recently with a paper on the unintended consequences of promoting breast-feeding as a “natural” practice — and relating it to the anti-vaccine movement.

University of Pennsylvania ethicist Anne Barnhill and medical historian Jessica Martucci, writing last month in the journal Pediatrics, suggest that by using the word “natural” in campaigns endorsing breast-feeding, public health officials and medical professionals may be inadvertently fueling other groups that reject public health efforts — like anti-vaxxers. Continue reading

Parents’ Depression May Impact Children’s Classroom Performance, Study Finds

A study found that depression in parents may negatively affect their children’s school performance. (Hadley Green for WBUR)

A study found that depression in parents may negatively affect their children’s school performance. (Hadley Green for WBUR)

Joshua Eibelman
CommonHealth Intern

Are your mood swings and depression hurting your children in the classroom?

A new study that followed more than a million Swedish children and their parents suggests the answer may be “yes.”

The Drexel University study, published in the journal JAMA Psychiatry, found that depression in parents may negatively affect their children’s school performance.

Researchers used Sweden’s computerized health and population records, allowing them to analyze parents’ inpatient medical records from 1969 onward and outpatient records from 2001 onward, as well as education records for all children born in Sweden between 1984 to 1994.

Led by Hanyang Shen, a Drexel alumna, the study looked at how depression in parents at various stages of their children’s lives — before birth, after birth, at ages 1-5, 6-10 and 11-16 years, and anytime before the final year of school at age 16 — was connected to school performance.

The study’s conclusion? Both “maternal depression and paternal depression at any time before the final compulsory school year were associated with worse school performance,” researchers wrote.

Specifically, depression in mothers was found to be linked to a 4.5 percent decrease in grades  while paternal depression resulted in a 4 percent decrease, compared with children without depressed parents.

Worryingly, maternal depression was more strongly associated with worse school performance for children than lower family income, which was linked to a grade decrease of 3.6 percent, researchers wrote.

Continue reading

Calls For Better Pain Relief Measures For Newborns, Premature Infants

In this file photo, an infant is seen in the neonatal intensive care unit of the Swedish Medical Center in Seattle. (Paul Joseph Brown/AP)

In this file photo, an infant is seen in the neonatal intensive care unit of the Swedish Medical Center in Seattle. (Paul Joseph Brown/AP)

What could be more heartbreaking than witnessing some of the smallest, sickest babies undergoing painful medical procedures?

Yet that’s precisely the population subject to some of the most intrusive prodding and pricking, the “greatest number of painful stimuli” in the neonatal intensive care unit, or NICU.

Now the American Association of Pediatricians is calling for better, more comprehensive pain relief measures for newborns, including those born prematurely — both with medications and through alternative, non-drug measures — and for more research on effective treatments.

The AAP’s updated policy statement, published in the journal Pediatrics, asserts that “although there are major gaps in our knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor yet painful procedures.”

The AAP calls for new measures, specifically:

Every health care facility caring for neonates should implement an effective pain-prevention program, which includes strategies for routinely assessing pain, minimizing the number of painful procedures performed, effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and eliminating pain associated with surgery and other major procedures.

If you’ve ever been in a NICU, you may have seen these types of procedures take place: suctioning of various secretions from the nose and throat; blood draws from veins, arteries, feet or heels; IVs being placed; adhesive tape — used to keep all those tubes and IVs in place — removed.

A landmark 2008 study from France found that the vast majority of newborns in the NICU didn’t get pain relief; researchers found only about 21 percent of infants were given either pain medication or non-drug pain relief before undergoing a painful procedure.

Why is this important? Continue reading

Study: Maternal Obesity And Diabetes Bring ‘Multiple Hits,’ May Raise Autism Risk In Children

A provocative new study finds that children born to mothers with a combination of obesity and diabetes before and during pregnancy may have up to four times the risk of developing autism spectrum disorder.

On their own, obesity as well as pre-pregnancy diabetes or gestational diabetes increase the risk of autism slightly, researchers report. But the study suggests that co-occurring obesity and diabetes may bring “multiple hits” to the developing fetal brain, conferring an even higher risk of autism in the offspring than either condition on its own.

According to the U.S. Centers for Disease Control and Prevention, about 1 in 68 children has autism spectrum disorder, which also includes Asperger syndrome and other pervasive developmental disorders.

This new study — led by researchers at the Johns Hopkins Bloomberg School of Public Health and published in the journal Pediatrics — was based on analyzing the medical records of 2,734 children who have been followed from birth at the Boston Medical Center between 1998 and 2014. (Of that group, 102 of the children had a diagnosis of an autism spectrum disorder. )

So what might be leading to this increased autism risk? Researchers don’t really know, but they raise several theories in the paper. In general, the possible mechanisms relate to immune and metabolic system disturbances associated with maternal obesity and diabetes that might cause inflammation and other problems for the developing fetus.

One of the study authors, Daniele Fallin, an epidemiologist and chair of the Department of Mental Health at Hopkins’ public health school, said in an interview: “We know that both diabetes and obesity create stress on the body, generally, and a lot of that stress manifests in disruption of immune processes and inflammation. Once you have the disruption in the mom, that may lead to inflammation problems in the developing fetus, and inflammation during neurodevelopment can create problems that manifest as autism.” Continue reading

More Evidence That Growing Up Poor May Alter Key Brain Structures

Allan Ajifo/flickr

(Allan Ajifo/Flickr)

Poverty is bad for your brain.

That’s the basic takeaway from an emerging body of research suggesting that the distress associated with growing up poor can negatively influence brain development in many ways, and in certain cases might also lead to emotional and mental health problems, like depression.

The latest study, led by researchers at Washington University School of Medicine in St. Louis, found that poverty in early childhood may influence the development of important connections between parts of the brain that are critical for effective regulation of emotions.

The study, published in the Journal of American Psychiatry, adds “to the growing awareness of the immense public health crisis represented by the huge number of children growing up in poverty and the likely long-lasting impact this experience has on brain development and on negative mood and depression,” researchers report.

Continue reading

Opinion: ‘Lactivism’ Has Trump-Like Appeal For Breastfeeding Backlash, But Science Is Off

A baby sleeps in the arms of his mother after breastfeeding. (Nikolas Giakoumidis/AP)

A baby sleeps in the arms of his mother after breastfeeding. (Nikolas Giakoumidis/AP)

By Melissa Bartick, M.D.

Judging from the hype around Courtney Jung’s new book “Lactivism,” breastfeeding backlash is alive and kicking. In fact, if Donald Trump suddenly jumped into the breastfeeding fray, he might sound a bit like Jung: In her world, breastfeeding advocates are nearly always “lactivists,” self-righteous extremists preying on innocent mothers in the name of science and good parenting.

Jung, a professor in the Department of Political Science at University of Toronto, conjures a villain (or villains) everyone can rally against, as evidenced in the book’s subtitle: “How Feminists and Fundamentalists, Hippies and Yuppies, and Physicians and Politicians Made Breastfeeding Big Business and Bad Policy.”

If only some of the glowing book reviews mentioned Jung’s sloppy reading of the scientific literature, her absurd claims about the breastfeeding industrial complex and her misplaced theories of breastfeeding class warfare.

Let’s be clear: There is no place for shaming any mother about how she feeds her infant. There are indeed people out there who deserve our ire, who shame and pressure women instead of listening and educating. But Jung lumps nearly all breastfeeding advocates into this camp, stoking hatred of an entire group where only some are guilty.

Perhaps the book is popular for the same reason Trump is popular. It taps into mothers’ collective anxiety, anger and fears over a highly emotional topic, and then hold up twin “culprits”: breastfeeding zealots and bad science. The only problem is, the actual zealots are few (though offensive), and the science is not as Jung states.

Here are some facts: Breastfeeding mothers still get harassed in public and at work, and formula feeding mothers are subject to shame as well. For decades, formula feeding has been the norm in this country, and for much of our society it’s still the norm. CDC data show low-income women and African-American women have lower breastfeeding rates than middle class white women.

Not everyone can breastfeed and not everyone wants to breastfeed, but data show 68 percent of women who want to exclusively breastfeed do not meet their own goals.

To be fair, Jung does a few things right. For instance, a 2007 report from the Agency for Health Research and Quality (AHRQ) found that exclusively breastfeeding for three months cuts the risk of ear infections in half. To her credit, Jung highlights the same data from a different perspective, illustrating that six babies would need to be exclusively breastfed for three months to prevent one ear infection. And, also to her credit, she highlights fairly recent data showing little if any link between breastfeeding and lower risk of asthma, eczema and type 1 diabetes.

But overall, Jung’s grasp on the medical research is poor. Scientific papers are peer reviewed by other researchers who are experts in the same field and must pass rigorous standards before publication. Jung is not a medical researcher. While I don’t know if Jung’s book was reviewed by any medical authority, as a reviewer myself I can say it never would have made it past the first stage of the peer review process. It was reviewed by editors whose goal is to sell books.

She misstates so much of the medical literature, one wonders if she did more than just skim through these papers. Here are a few examples of inaccuracies:

• The rate of HIV transmission from mothers to their 6-month-old infants via breast milk is 4 percent among those exclusively breastfed, according to a study in The Lancet; Jung wrongly puts that number at 22 percent. Continue reading

Sweeping Harvard Study Finds Skin-To-Skin ‘Kangaroo Care’ Helps Preemies Thrive

If a premature baby is medically stable, a study finds the practice of holding the tiny child might well do some good. (BradleyOlin/Flickr)

If a premature baby is medically stable, a study finds”kangaroo care” — including prolonged skin-to-skin contact — might well do some good. (BradleyOlin/Flickr)

You want to hold your baby. It’s surely one of the deepest of human instincts. But if your newborn is among the nearly 10 percent who arrive prematurely in America each year, you may need to wait — until the days of tubes and high-tech monitors in the incubator have passed.

Now, a new study, apparently the most sweeping yet, offers added evidence that if a premature baby is medically stable, the age-old practice of holding the tiny child — skin to skin, heartbeat to heartbeat — might well do some good. A survey of more than 100 previous studies, it found that overall, the skin-to-skin cradling widely known as “kangaroo mother care” may cut a premature, low-birth-weight baby’s risk of death by 36 percent.

The findings may rightly spur parents to advocate for holding their preemies once they’re medically stable enough, says the study’s senior author, Dr. Grace Chan of Boston Children’s Hospital and the Harvard Chan School of Public Health.

“With this degree of evidence, it doesn’t hurt to ask,” she says. High-tech medical interventions “are necessary for many conditions,” she says. “At the same time, for your preterm, low-birth-weight baby who’s otherwise stable, this is the best thing for the baby.”

Kangaroo care is considered most useful in low-income areas where high-level-care hospitals — and incubators — are few. But Dr. Chan says it seems to offer benefits across all settings. The new study, in the journal Pediatrics, quantifies those benefits, finding both the 36 percent drop in risk of death and a 47 percent drop in infection or sepsis. It looked at newborns who weighed less than 2 kilograms, or 4.4 pounds.

My own son weighed just about that when he was born two months early, back in 2004. And I remember the joy of the brief periods when we were allowed to extract him from his incubator home for a few minutes and hold him close. Judging by that Boston hospital experience, I asked Dr. Chan, kangaroo care is fairly widely accepted, right? Continue reading

Parents: Kids Spurn Emotional Help For Fear ‘They Might Think I’m The Next Shooter’

Candles spelling UCC -- for Umpqua Community College -- are displayed at a candlelight vigil for those killed during a fatal shooting at the school, Thursday in Roseburg, Oregon. (Rich Pedroncelli/AP)

Candles spelling UCC — for Umpqua Community College — are displayed at a candlelight vigil for those killed during a fatal shooting at the school in Roseburg, Oregon. (Rich Pedroncelli/AP)

By Lisa Lambert
Guest contributor

Lisa Lambert is the executive director of the Parent/Professional Advocacy League, which is subtitled “The Massachusetts Family Voice For Children’s Mental Health.”

“He doesn’t want to take the risk and have someone think he could be a shooter,” one mother said, “just because he has a mental health diagnosis.”

I was at a meeting with other parents whose children have mental health needs. This mother told us her son was reluctant to leave his high school classroom for an important evaluation, which included psychological testing.

Like much of America, we were talking about the recent and not-so-recent shootings on campuses and in communities across the country. For this mother, as with many parents whose children have mental health issues, the conversation is far more personal and troubling than for most.

Some parents said that in response to recent shooting incidents, their children are dropping out of services or refusing school supports so they won’t risk their peers or teachers finding out why they get treatment.

As a parent, this breaks my heart. Young adults shouldn’t have to choose between the safety found in avoiding treatment and the healing found in seeking it.

Lisa Lambert (courtesy)

Lisa Lambert (courtesy)

During our discussion, another mother reported that her son was in his first year of college and struggling to complete all his coursework. Freshman year is a stressful time for many students and even more so for students with depression. Because her son had had special education services in high school, he could access supports there to help him manage his academic and emotional stress.

She encouraged him to go to the college student services office to get help. He responded, “I’d rather drop the classes I am most behind in. If I go there, the professors and other students will know I have mental health problems. They might think I could be the next shooter.”

Often, as a news channel covers the latest shooting, the speculation immediately jumps to mental illness. Continue reading

Study: Thousands Of Injuries As Ziplines Proliferate, Younger Kids Most At Risk

In 2012 alone, there were over 3,600 zipline-related injuries, according to a recent report, or about 10 a day. (popejon2/Flickr)

In 2012 alone, there were over 3,600 zipline-related injuries, according to a recent report, or about 10 a day. (popejon2/Flickr)

Hannah Weyerhauser was 5 years old, playing on the zipline at her family’s house in New Hampshire, when she started complaining that her older cousins and siblings were going faster than she was. So her mother, Annie, gave Hannah an extra big push. But when Hannah sped to the end of the zipline, she stopped short, flew into the air, did a back flip, and landed on her neck.

“For a few minutes she was really pale and out of it,” said her mother, a Boston doctor (and a friend of mine). She called an ambulance, and paramedics put a collar on Hannah’s neck on the way to the local emergency department. Ultimately, the little girl was fine, although she probably had a minor concussion, her mother said. But Annie shudders as she thinks of what could have happened: “If she had fallen a little differently she could have broken her neck.”

Others are not so lucky. Increasingly, zipline disasters are making the news. A 12-year-old girl in North Carolina died after falling off a zipline at the YMCA’s Champ Cheerio in June. And last year, a 10-year-old boy died after a backyard zipline accident in Easton, Massachusetts, in which the tree holding the line fell on the child.

Indeed, injuries related to ziplines are rising as the lines proliferate, according to a new report: In 2012 alone, there were over 3,600 zipline-related injuries, or about 10 a day. The study, which researchers say is the first to characterize the epidemiology of zipline-related injuries using a nationally representative database, found that from 1997-2012, about 16,850 zipline-related injuries were treated in U.S. emergency departments.

Which states have zipline regulations (Source: Association for Challenge Course Technology)

Which states have zipline regulations (Source: Association for Challenge Course Technology)

The report on ziplines (first used over a century ago to transport supplies in the Indian Himalayas) found that most of the injuries resulted from falling off the zipline, and many involved young children. I asked one of the study authors, Tracy Mehan, manager of translational research with the Center for Injury Research and Policy at Nationwide Children’s Hospital in Ohio, a few questions about the report, published in the American Journal of Emergency Medicine.

Here, edited, is what she said.

Rachel Zimmerman: Are you surprised by this sharp increase in zipline injuries?

Tracy Mehan: The number of commercial ziplines grew from just 10 in 2001 to over 200 by 2012. When you include the number of amateur ziplines that can also be found in backyards and at places like outdoor education programs and camps, the number skyrockets to over 13,000. The increase in the number of injuries is likely due largely to the increase in number of ziplines and shows this is a growing trend. 

What are the most common types of injuries?

The majority of zipline-related injuries were the result of either a fall (77 percent) or a collision (13 percent) with either a tree, a stationary support structure or another person. The most frequent type of injuries were broken bones (46 percent), bruises (15 percent), strains/sprains (15 percent) and concussions/closed head injuries (7 percent). Approximately one in 10 patients (12 percent) were admitted to the hospital for their injury. Continue reading

Bugs And Kids: Indoor Insecticide Use Linked To Childhood Cancers, Study Finds

(Tom Simpson/Flickr)

(Tom Simpson/Flickr)

I just threw out my spray can of Raid for flying insects. With kids in the house, I never did like the idea of spewing toxic stuff around, and only ever used it when a bug was driving me to feral insanity. Now, after reading the paper just out in this week’s issue of the journal Pediatrics, I’ll stick with the flypaper and swatter no matter how intense my irritation.

The paper concludes that the sum of previous research suggests a significant link between indoor pesticide use and childhood cancer.

To be more exact, senior author Chensheng Lu says the results “suggest that when kids are exposed to pesticides — especially a group of pesticides we call insecticides — in the indoor residential environment, kids have 43 to 47 percent more chance of having childhood cancers, specifically leukemia and lymphoma.”

Dr. Lu is an associate professor of environmental exposure biology at the Harvard T.H. Chan School of Public Health. He acknowledges the study’s limitations, in particular that it could find only 16 relevant previous papers to analyze. But, he says, it showed “consistent results in terms of the positive correlation between exposure to insecticide indoors and childhood cancer.”

The study does not aim to “cause fear in parents,” Lu says. “But it’s to give you a precautionary principle that those exposures can be prevented, can be mitigated or can be completely removed.”

Of course, these findings only heighten the dilemma for households or schools that are tormented by pests, with infestations too fierce to be dented by anything but the big toxic guns. Are we supposed to just let the roaches and mosquitoes run wild?

Dr. Lu points out that preventive measures like window screens and hole-plugging can help, and among pesticides, some applications are safer than others — for example, “bait houses” that try to attract the pest inside a box-like structure to be poisoned.

“The worst-case scenario in terms of indoor pesticide use and human exposure it to use some kind of fogger,” he says. “Also, some kind of open-air application, a broadcast application, a spray can. Those are bound to significant exposures.” Continue reading