Pediatrics

• Breastfeeding
• Child-Adolescent Nutrition and Overweight
• Diagnosis, Imaging, Screening
• Diseases and Conditions
• General Information
• Guidelines
• Internet Sites
• Immunization
• Infant Nutrition
• Risk Factors
• Risk Reduction
• SIDS (Sudden Infant Death Syndrome)
• Treatment

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REVIEW our Selected Pediatric Articles in 2007. Stay informed and updated!

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Breastfeeding

NIH – Breastfeeding (Medical Encyclopedia) “Recommendations: Choosing how and what to feed your baby is a personal decision that deserves careful and thorough consideration. Breast milk is the natural nutritional source for infants less than one year of age. Most health care professionals (including the American Academy of Pediatricians and the National Association of Pediatric Nurse Associates and Practitioners) recommend breastfeeding for your baby's first year. Breast milk is the best source of nutrition for the first 6 months of life. It contains appropriate amounts of carbohydrate, protein, and fat, and provides digestive enzymes, minerals, vitamins, and hormones that infants require. Breast milk also contains antibodies from the mother that can help the baby resist infections. Experts agree that breastfeeding your baby for any length of time, regardless of how short, is of benefit to you and your baby. You can provide your baby with breast milk directly by breastfeeding or by feeding your baby breast milk from a bottle. ... ADVANTAGES OF BREASTFEEDING Research shows that breastfed babies may have less frequent: • Ear infections • Stomach or intestinal infections • Low iron levels in the blood (iron-deficiency anemia) • Skin diseases (infantile eczema) • Infant allergies Breastfed babies may have less risk of developing: • Digestive problems such as constipation or diarrhea • Obesity or becoming overweight • High blood pressure • Diabetes • Tooth decay”

NIH – Breastfeeding “What are the benefits of breastfeeding? Breastfeeding offers many benefits to the baby: Breast milk provides the right balance of nutrients to help an infant grow into a strong and healthy toddler. Breastfed infants, and those who are fed expressed breast milk, have fewer deaths during the first year and experience fewer illnesses than babies fed formula. Some of the nutrients in breast milk also help protect an infant against some common childhood illnesses and infections, such as diarrhea, middle ear infections, and certain lung infections. Some recent NICHD-supported research also suggests that breast milk contains important fatty acids (building blocks) that help an infant's brain develop. Two specific fatty acids, known as DHA and AA, may help increase infants’ cognitive skills. Many types of infant formulas available in the United States are fortified with DHA and AA, and all formula available for preterm infants is fortified with these fatty acids.”

NHS - Breast-feeding (Video)

Highlighted Articles

Breastfeeding and Child Cognitive Development (Arch Gen Psychiatry. 2008) “Conclusion These results, based on the largest randomized trial ever conducted in the area of human lactation, provide strong evidence that prolonged and exclusive breastfeeding improves children's cognitive development.”

Advances in our understanding of the biology of human milk and its effects on the offspring. (J Nutr. 2007) "The most important short-term immunological benefit of breast-feeding is the protection against infectious diseases. There is also some evidence of lower prevalence of inflammatory bowel diseases, childhood cancers, and type I diabetes in breast-fed infants, suggesting that breast-feeding influences the development of the infant's own immune system. One of the most consistent findings of breast-feeding is a positive effect on later intelligence tests with a few test points advantage for breast-fed infants."

Optimal duration of exclusive breastfeeding: what is the evidence to support current recommendations? (Am J Clin Nutr. 2007) "That review concluded that infants exclusively breastfed for 6 mo experienced less morbidity from gastrointestinal infection and showed no deficits in growth but that large randomized trials are required to rule out small adverse effects on growth and the development of iron deficiency in susceptible infants. Others have raised concerns that the evidence is insufficient to confidently recommend exclusive breastfeeding for 6 mo for infants in developed countries, that breast milk may not meet the full energy requirements of the average infant at 6 mo of age, and that estimates of the proportion of exclusively breastfed infants at risk of specific nutritional deficiencies are not available. Additionally, virtually no data are available to form evidence-based recommendations for the introduction of solids in formula-fed infants. Given increasing evidence that early nutrition and growth have effects on both short- and longer-term health, it is vital that this issue be investigated in high-quality randomized studies."

Immunization

NIH - Immunizations - general overview (Medical Encyclopedia) “IMMUNIZING CHILDREN: Babies get so many shots these days! Many parents are concerned that the sheer number of vaccines might overwhelm, weaken, or use up a baby's immature immune system. But a baby's immune system is built to make antibodies to as many as 10,000 foreign proteins. If a baby were to receive all 11 available vaccines at once, this would engage only a tiny fraction of the immune system. … IMMUNIZATION SCHEDULE The recommended immunization schedule is updated at least every 12 months by organizations such as the American Academy of Pediatrics. Consult your primary care provider about specific immunizations for you or your child. The current recommendations are available on the Centers for Disease Control and Prevention (CDC) website at www.cdc.gov/vaccines. At every doctor visit, ask about the next recommended immunizations.”

NIH - Childhood Immunization “Vaccines help make you immune to serious diseases without getting sick first. Without a vaccine, you must actually get a disease in order to become immune to the germ that causes it. Vaccines work best when they are given at certain ages. For example, children don't receive measles vaccine until they are at least one year old. If it is given earlier it might not work as well.”

CDC - Recommended Immunization Schedules for Persons Aged 0--18 Years --- United States, 2008

CDC - Immunization Schedules (USA)

Childhood Vaccines: What They Are and Why Your Child Needs Them “Are there any reasons my child should not be vaccinated? In some special situations, children shouldn't be vaccinated. For example, some vaccines shouldn't be given to children who have certain types of cancer or certain diseases, or who are taking drugs that lower the body's ability to resist infection. The MMR vaccine shouldn't be given to children who have a serious allergy to eggs. If your child has had a serious reaction to the first shot in a series of shots, your family doctor will probably talk with you about the pros and cons of giving him or her the rest of the shots in the series. Talk to your doctor if you have any questions about whether your child should receive a vaccine.”

CDC - Common Questions Parents Ask about Infant Immunizations

NHS – Childhood immunisations (UK) “Childhood immunisation prevents a large variety of diseases. These include: Tetanus. An infection found in the soil that causes severe muscle contractions and breathing difficulties. Polio (short for poliomyelitis). A virus that first attacks the gut (bowel) but then travels to the nervous system. Polio can cause paralysis (when you can't move your limbs) in one or more parts of your body. Pneumococcal infections. These can affect anyone, but young children are at an increased risk of developing serious complications such as meningitis. Diphtheria. A highly contagious disease caused by a bacterium called Corynebacterium diphtheriae. It causes a serious throat and chest infection. Meningitis C. Caused by the meningococcus group c bacterium. In rare cases it can lead to blood poisoning and serious types of meningitis. Hib (full name is haemophilus influenzae type b). A bacterium that can cause pneumonia and meningitis. Whooping cough (pertussis) - causes prolonged coughing that can be very distressing. In children, complications can include brain damage. Measles. Caused by the measles virus and can result in a serious fever and rash. In severe cases, measles can be fatal. Mumps. Caused by the mumps virus. Mumps usually leads to inflammation and swelling of the salivary glands (the glands located just below the ears). In severe cases this can cause deafness. Rubella (also know as German measles). Caused by the rubella virus and can lead to a mild illness and rash. In later life rubella can be serious to an unborn child as it can potentially lead to several birth defects. Other immunisations Some children may require additional immunisations that are not part of the childhood immunisation programme. Your GP will be able to advise you if your child requires any further immunisations. These may include immunisations if your child has a chronic condition.”

Highlighted Article

Thimerosal exposure in infants and neurodevelopmental disorders: An assessment of computerized medical records in the Vaccine Safety Datalink. (J Neurol Sci. 2008) “Routine childhood vaccination should be continued to help reduce the morbidity and mortality associated with infectious diseases, but efforts should be undertaken to remove Hg from vaccines.”

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Pediatrics

General Information

NEWS:

Bisphenol A Safe, Says FDA: FDA Issues Draft Report on Bisphenol A Noting "Adequate Margin of Safety" in Typical Exposure From Food “Bisphenol A safety became a hot topic in April, when U.S. government scientists at the National Toxicology Program (NTP) expressed "some" concern about bisphenol A's possible effects on the mammary gland, prostate gland, and accelerated female puberty. Since then, there's been a storm of bisphenol A publicity, with major retailers including Wal-Mart backing away from baby bottles containing bisphenol A, the FDA probing bisphenol A safety, and consumers wondering how concerned they should be. “

Canada Says BPA Toxic, to Ban Baby Bottles With It “Canada declared a chemical widely used in food packaging a toxic substance on Saturday and will now move to ban plastic baby bottles containing bisphenol A. The toxic classification, issued in the Canada Gazette, makes Canada the first country to classify the chemical commonly used in the lining of food cans, eyeglass lenses and hundreds of household items, as risky. "Many Canadians...have expressed their concern to me about the risks of bisphenol A in baby bottles," Environment Minister John Baird said in a statement. "Today's confirmation of our ban on BPA in baby bottles proves that our government did the right thing in taking action to protect the health and environment for all Canadians." Canada's announcement came six months after its health ministry labeled BPA as dangerous.”

Children Drinking 100% Fruit Juice Daily May Have Better Nutrient Intake “Children ages 2 to 11 years old who consume 100% juice daily have better nutrient intake without an increased risk for overweight or obesity, according to the results of a cross-sectional study reported in the June issue of the Archives of Pediatrics & Adolescent Medicine. "Recent studies using national samples have shown no association between consumption of 100% fruit juice and weight," write Theresa A. Nicklas, DrPH, from Baylor College of Medicine in Houston, Texas, and colleagues. "The 2 objectives of this study were to determine if, in a nationally representative sample of children 2 to 11 years of age, 100% juice consumption affected (1) nutrient intake and food groups and (2) weight status." “

Close Ties Between Parents And Babies Yield Benefits For Preschoolers “Having close ties with parents is obviously good for preschoolers, but what does that really mean? It means that the preschoolers are better able to control their own behavior by showing patience, deliberation, restraint, and even maturity. That's the finding of a new study conducted by researchers at the University of Iowa. … The researchers also explored how mutually responsive relationships between mothers and children worked. When mothers and babies develop this closeness in the first two years, the study found, mothers don't need to use forceful discipline later to get their children to do what they ask and refrain from other behaviors. And in turn, subtle control on the part of the mothers leads to better, more compliant, and more self-regulated behavior when the children are at preschool age.”

Drug companies: No cold meds for kids under 4 “Children under 4 should not be given over-the-counter cough and cold remedies, drug companies said Tuesday in a concession to pediatricians who doubt the drugs work in kids and worry about their safety. The voluntary changes came less than a week after federal health officials said they also saw little evidence that the drugs work, but feared that parents would give kids adult medicines if the products were taken off store shelves.”

Fire Retardants Found in Children's Blood “Young children have three times the blood levels of fire-retardant chemicals as their mothers, according to a new study by the Environmental Working Group. The chemicals are routinely used in common household items such as furniture, mattresses, and electronics. The gap between mothers and their children was a surprise finding. Because of typically similar diet and exposures in the same household, "we would have expected similar levels," says Anila Jacob, MD, MPH, a senior scientist at EWG. "What we found was, kids on average had three times the levels of toxic retardants polluting their blood compared to their moms." The chemicals are hormone-disrupting and potentially hazardous, especially to young brain development, Jacob and her colleagues say. But a spokesman for the flame retardant industry countered that the levels of chemicals, known as PBDEs or polybrominated diphenyl ethers, found in the study are quite low, in the parts per billion range. “

FTC Report Sheds New Light on Food Marketing to Children and Adolescents ““Our study makes a path-breaking contribution to understanding how food and media industries are marketing food to youth,” said FTC Chairman William E. Kovacic. “We call on both industries to deploy their talents to promote healthier choices for children and adolescents.” “

Grandma And Grandpa Are Good For Children “The survey reveals that grandparents often have more time than working parents to support young people in activities and are well placed to talk to their grandchildren about any problems the young people may be experiencing. They were also found to be involved in helping to solve the young people’s problems, as well as talking with them about plans for their future.”

Guidelines Address Physical Activity for Individuals 6 Years and Older “Regular physical activity each week, sustained for months and years, can produce long-term health benefits. Strong evidence links regular physical activity with a lower risk for early death, heart disease, stroke, type 2 diabetes, hypertension, hyperlipidemia, metabolic syndrome, colon and breast cancers, and depression. Regular physical activity also promotes prevention of weight gain, weight loss when combined with diet, better cardiorespiratory and muscular fitness, fall prevention, and better cognitive function in older adults.”

Kids May Need 10 Times More Vitamin D: Study: Kids Need 2,000 IU of Vitamin D, Not 200 IU Now Recommended

Lawmakers Agree to Ban Toxins in Children's Items

Maltreatment in Childhood Linked to Depression and Inflammation Later in Life “ “The results suggest that a history of maltreatment has a significant role in explaining the co-occurrence of depression and inflammation in adults," the authors write. “Information about experiences of childhood maltreatment may help to identify depressed individuals with elevated inflammation levels and, thus, a greater risk of cardiovascular disease.” Routinely assessing a depressed patient’s maltreatment history could provide clinicians with necessary information to identify those with elevated risk of inflammation and poor health, they add. “In turn, the early recognition of the health risk associated with maltreatment history might help to address pressing needs for the care of depressed individuals such as the reduction of the effect of depression on comorbid medical illness.” How might maltreatment in childhood lead to inflammation? The authors speculate that it may be because depressed and maltreated people have a smaller volume of hippocampus, an area of the brain involved in the termination of the stress response. Or, it could be related to glucocorticoids: adults with a history of maltreatment have reduced function of these hormones, and, because these hormones are involved in the anti-inflammatory response, reduced function may lead to elevated inflammation levels. Although childhood maltreatment appeared to predict elevated inflammation levels in depressed individuals, the authors point out that not all depressed individuals with elevated inflammation levels had been maltreated.”

Mercury Low in Wild and Farmed Salmon “Levels of mercury and other trace metals in both wild and farmed salmon taken from Canadian waters were found to be well below those considered safe, a new study shows. Total mercury levels in the wild salmon tested were three times higher than in farmed, but total mercury intake from both types of fish was found to be lower than from many other foods. “

Moms, Tots Argue 20 Times an Hour: It's Not Just the Temperamental Toddlers Who Clash With Mom, Study Shows “That average is based on a wide range of hourly quarrels, from a low of four conflicts per hour to a high of 55 arguments per hour. Remember, the moms and kids were only studied during times when conflict was likely; they probably didn't clash like that around the clock. Those conflicts were more likely to get resolved without major drama if the kids had a good relationship with their mother and weren't especially temperamental, active, or impulsive, according to surveys completed by the moms. Those factors didn't affect the frequency of the mother-child conflicts. Such conflicts are normal and frequent during the toddler and early preschool years, Laible's team writes.“

Non-Toxic Tots: Parents Pay Dearly for Safety “Last summer, the Centreville couple started looking for an organic crib mattress because they wanted to avoid exposing their daughter, Samantha, now 8 months old, to potentially harmful flame-retardant chemicals used in mattress filling. Then "it all sort of snowballed," Cunningham said. She and her husband now use cloth diapers because they are concerned about chemicals that help make disposable diapers absorbent and about the impact of diapers on landfills. They painted the nursery with a special kind of paint that is formulated so it doesn't release harmful gases. The couple would have kept going until every item in the nursery met their standards, but given that the prices for organic furnishings can be 15 to 20 percent higher than conventional ones and 50 to 100 percent higher for clothing, the couple decided to spend the bulk of their budget on the things the baby would be in contact with for the most hours each day. They bought a $500 handmade crib from Oregon coated in a non-toxic wax finish and a $230 crib mattress made of organic cotton and wool.”

Personality may be set by preschool “New research shows that in most cases the personalities displayed very early in life — as young as preschool — will stay with us into adulthood. The wallflowers will stay shy and reticent, though they will learn in time to be a little more sociable and assertive. And the average kids, the more resilient ones, will remain so. “

Recognize and Prevent MRSA Infections “As kids head back to classrooms and sports venues, parents are encouraged to learn how to recognize and prevent skin infections caused by methicillin-resistant Staphylococcus aureus (MRSA), a type of staph bacteria that is resistant to certain antibiotics. It is estimated that Americans of all ages visit the doctor more than 12 million times per year for skin infections that are typical of staph, more than half of which are MRSA. The good news is that a few simple steps can help parents protect their families.“

Saline Nasal Wash Helps Kids Fight Colds, Flu

Speech and language development milestones: Birth to 24 months

Study: Restaurant Kids' Meals Loaded With Calories

Study: Spanking May Lead to Sexual Problems Later “Children whose parents spank them or otherwise inflict physical punishment may be more likely to have sexual problems later, according to research to be presented Thursday to the American Psychological Association. … Gershoff says that though many children have been spanked (85 percent in one 2007 survey), problems may depend on how they process the spanking. "They may internalize that to mean that in loving relationships sometimes there's pain or physical aggression," she says. Another possible lesson is that "whoever is stronger and has more power can overpower the other person and use physical aggression to control the other person's behavior." But linking sexual problems with spanking is a "big leap," says human-sexuality researcher John DeLamater of the University of Wisconsin. "It's probably one of many elements that might contribute to sex problems or risky sex, but it's a long leap." Most children who are spanked escape from long-term harm, says Straus, 81, a sociology professor who says he occasionally spanked his own children but later became a staunch critic of spanking. His work on violence in families is regarded as landmark research. “

Taking Play Seriously “Educators fret that school officials are hacking away at recess to make room for an increasingly crammed curriculum. Psychologists complain that overscheduled kids have no time left for the real business of childhood: idle, creative, unstructured free play. Public health officials link insufficient playtime to a rise in childhood obesity. Parents bemoan the fact that kids don’t play the way they themselves did — or think they did. And everyone seems to worry that without the chance to play stickball or hopscotch out on the street, to play with dolls on the kitchen floor or climb trees in the woods, today’s children are missing out on something essential.”

Teens Who Have TV In Their Bedroom Are Less Likely To Engage In Healthy Habits, Study Shows “University of Minnesota School of Public Health researchers have found that older adolescents who have a bedroom television are less likely to engage in healthy activities such as exercising, eating fruits or vegetables, and enjoying family meals. They also consumed larger quantities of sweetened beverages and fast food, were categorized as heavy TV watchers, and read or studied less than teens without TVs in their bedrooms.”

Vitamin D: New Guidelines for Children: American Academy of Pediatricians Doubles Its Minimum Daily Amount of Vitamin D for Babies, Children, and Teens “The American Academy of Pediatrics has doubled its recommendation for the minimum amount of vitamin D that infants, children, and teens should get daily. The new recommendation is to get at least 400 international units (IU), according to guidelines published by the American Academy of Pediatrics (AAP) in November's edition of Pediatrics. "We know that 400 international units a day is safe and it will prevent rickets," Frank R. Greer, MD, chairman of the AAP's committee on nutrition, tells WebMD. The new guidelines are especially important for breastfed babies, since breast milk isn't rich in vitamin D, notes Greer, who recommends supplements to ensure adequate vitamin D intake. Some vitamin D experts say the AAP's new vitamin D guidelines don't go far enough.“

Winners Do Not Punish: Punishment Does Not Earn Rewards Or Cooperation, Study Finds “"Put simply, winners don't punish," says co-author David G. Rand of Harvard's Program for Evolutionary Dynamics and Department of Systems Biology. "Punishment can lead to a downward spiral of retaliation, with destructive outcomes for everybody involved. The people with the highest total payoffs do not use costly punishment." “

ARTICLES:

Radiology and Children: Extra Care Required

Tantrums — Understanding, Preventing and Surviving Them

JOURNAL ARTICLES:

Emotional problems and prevalence of medication overuse in pediatric chronic daily headache. (J Child Neurol. 2007) “Patients with chronic daily headache were at higher risk for emotional disorders, and medication overuse was a significant occurrence, suggesting a need for multisystem treatment approach.”

Enhancing Parenting Practices of At-risk Mothers. (J Prim Prev. 2008)

Exercise and the obese child (Progress in Pediatric Cardiology 2008)

Longitudinal risk factors for persistent fatigue in adolescents. (Arch Pediatr Adolesc Med. 2008)

Moderate-to-Vigorous Physical Activity From Ages 9 to 15 Years (JAMA 2008) “Conclusion In this study cohort, measured physical activity decreased significantly between ages 9 and 15 years. “

Nonfatal maltreatment of infants--United States, October 2005-September 2006. (MMWR Morb Mortal Wkly Rep. 2008)

Psychotic phenomena in 257 young children and adolescents with bipolar I disorder: delusions and hallucinations (benign and pathological). (Bipolar Disord. 2008) “…The most common delusion was grandiose … Conclusions: Counterintuitively, psychosis was equally prevalent in 6-9 compared to 10-16 year-olds. High prevalence of psychosis in child BP-I warrants focus in intervention strategies and is consistent with increasing evidence of the severity of child-versus adult-onset BP-I.”

SHORT-TERM AND LONG-TERM SAFETY OF WEEKLY HIGH-DOSE VITAMIN D3 SUPPLEMENTATION IN SCHOOL CHILDREN. (J Clin Endocrinol Metab. 2008) “Conclusion: Vitamin D3 at doses equivalent to 2,000 IU/day for one year is safe in adolescents and results in desirable vitamin D levels.”

Study Shows Better Parenting Skills Sharpen Minds of Kids in Poverty “Growing up poor has insidious effects on kids' mental abilities, beginning when they are very young. But there is new evidence that parents living in poverty can improve their children's chances for a better life by changing how they relate to them at home. … The parents learned to introduce "predictability where there were power struggles," Stevens says, and they were coached on how to converse with kids, "allowing the child a chance to contribute to and direct that communication experience. … It has been known for a long time that living in poverty damages children's intellectual abilities. Scientists have recently begun to understand why. It's not because of money, per se, and it's most certainly not a matter of being somehow inferior. It's the effect of unending stress and lack of proper social support. At a critical time in early childhood when the brain is developing, stress inhibits the formation of connections between brain cells and restricts blood flow to the brain. … Shonkoff argues that the importance of programs to aid poor children and their parents can't be underestimated because the effects last a lifetime. "The earlier we intervene, the better," Shonkoff says.” “

The Mental Health of US Adolescents Adopted in Infancy (Arch Pediatr Adolesc Med. 2008)

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