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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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

Child-Adolescent Nutrition and Overweight

NEWS:

Certain Behavioral Traits And Feeding Practices May Increase Risk For Weight Gain In Children

Eat Your Vegetables: Preschoolers Love Vegetables With Catchy Names Like 'X-Ray Vision Carrots' And 'Tomato Bursts' “Do you have a picky preschooler who's avoiding their vegetables? A new Cornell University study shows that giving vegetables catchy new names – like X-Ray Vision Carrots and Tomato Bursts – left preschoolers asking for more. … Although the study was conducted in pre-schools, the researchers believe the same naming tricks can work with children. "I've been using this with my kids," said researcher Collin Payne, "Whatever sparks their imagination seems to spark their appetite." “

Exercise Alone Shown To Improve Insulin Sensitivity In Obese Sedentary Adolescents

Kids Who Live Near Green Spaces Seem to Walk More “Living close to parks and other play areas may keep children more active and help combat the continued increase in childhood obesity, Canadian researchers report.”

Longer Bouts Of Exercise Help Prevent Childhood Obesity “Children who exercise in bouts of activity lasting five minutes or longer are less likely to become obese than those whose activity levels are more sporadic and typically last less than five minutes each, Queen’s University researchers have discovered.”

MRI Reveals High Incidence of Disc Disease in Overweight and Obese Youngsters “"Back pain and degenerative disc disease are yet another problem associated with obesity in children, along with type 2 diabetes," Dr. Judah G. Burns, a fellow in diagnostic neuroradiology, said. "Disc herniation and spinal disease are generally thought of as a problem of older people, but we're seeing it in obese youngsters, too. This is the first study to show an association between increased body mass index and disc abnormalities in children."”

Overweight Children at Risk for Spinal Problems

Overweight Male Teens With Normal Blood Pressures Showing Signs Of Heart Damage “Even while their blood pressures are still normal, overweight male teens may have elevated levels of a hormone known to increase pressures as well as early signs of heart damage, researchers say.”

Parents can help stop the obesity epidemic, says psychologist “Childhood obesity has quadrupled in the last 40 years, which may mean today's children become the first generation to have a shorter lifespan than their parents, a leading obesity expert told the American Psychological Association on Saturday. However, parents can help stave off this impending crisis if they help their children to eat better and exercise, according to Edward Abramson, PhD. Abramson, professor emeritus at California State University-Chico, teaches psychology and is author of the books "Body Intelligence" and "Emotional Eating." In the last decade, "we've seen a [tenfold] increase in Type-2 diabetes and psychological and social consequences, such as prejudice, rejection, discrimination and low self-esteem in children," Abramson said at APA's 117th Annual Convention. "More than 60 percent of overweight children have one risk factor for cardiovascular disease and 20 percent have two or more risk factors." Bad eating habits can start with "emotional eating," or eating when one is not hungry, or from following a strict diet, Abramson said. "This can lead to a weight problem or an eating disorder," he added. "Parents' attitudes and behaviors also have an influence on children's eating, and mothers more than fathers affect children's eating habits and body image." Many factors contribute to mothers' concern about their children's risk for obesity, Abramson said. "For example, there is evidence that minority parents (e.g., African-American, Hispanic) are less concerned about their children's weight," he said. "Often, when a mother is struggling with her own weight, she becomes more involved in regulating her daughter's eating. In general, mothers are more concerned than fathers about their child's weight, especially their daughter's, and are more likely to restrict foods." While everyone, including children, is entitled to have food preferences, infants are born with genetic predispositions toward sweet and salty tastes and against sour and bitter tastes and unfamiliar foods, Abramson said. "For these children, it may take several repetitions (10 or more) to have a child try a new food, but parents should retreat gracefully and try again another day rather than get into a battle of wills when the child refuses a food," he said.”

School near fast-food joint? Expect fatter kids “The study, released by the American Association of Wine Economists, showed that "the presence of a fast-food restaurant within a tenth of a mile of a school is associated with at least a 5.2 percent increase in the obesity rate in that school." It also found that pregnant women who lived within a tenth of a mile of a fast-food restaurant had "a 4.4 percent increase in the probability of gaining over 20 kilos (44 pounds)."“

Study Finds 1 in 5 Obese Among 4-Year-Olds “A striking new study says almost 1 in 5 American 4-year-olds is obese, and the rate is alarmingly higher among American Indian children, with nearly a third of them obese. Researchers were surprised to see differences by race at so early an age. Overall, more than half a million 4-year-olds are obese, the study suggests. Obesity is more common in Hispanic and black youngsters, too, but the disparity is most startling in American Indians, whose rate is almost double that of whites. The lead author said that rate is worrisome among children so young, even in a population at higher risk for obesity because of other health problems and economic disadvantages. “

Sugar-Sweetened Beverages, Physical Activity Independently Linked to Insulin Resistance “• A previous study found that each additional daily serving of sugar-sweetened beverages for children increased the risk for obesity by 60%. • In the current study, both lower consumption of sugar-sweetened beverages and higher physical activity improved metabolic and anthropometric outcomes. The combination of these 2 variables was synergistic in improving insulin resistance and concentrations of high-density lipoprotein cholesterol and triglycerides.”

ARTICLES:

JOURNAL ARTICLES:

Automobile traffic around the home and attained body mass index: A longitudinal cohort study of children aged 10 -18 years. (Prev Med. 2009) “CONCLUSIONS: This analysis yields the first evidence of significant effects from traffic density on BMI levels at age 18 in a large cohort of children. Traffic is a pervasive exposure in most cities, and our results identify traffic as a major risk factor for the development of obesity in children.”

Beverage intake of girls at age 5 y predicts adiposity and weight status in childhood and adolescence. (Am J Clin Nutr. 2009) “CONCLUSION: These findings provide new longitudinal evidence that early intake of sweetened beverages predicts adiposity and weight status across childhood and adolescence.”

Cardiovascular risks associated with obesity in children and adolescents. ( Ann Acad Med Singapore. 2009) “CONCLUSIONS: Early development of CVS risks in obese children and the possible continuation of CVS complications into adulthood have been observed. Obstructive sleep apnoea in obese children can further contribute to such CVS risks. These findings underscore the importance of prevention of childhood obesity as a priority over management of obesity in children.”

Childhood obesity in Australia remains a widespread health concern that warrants population-wide prevention programs (Med J Aust 2009) “Some commentators downplay the health implications of childhood and adolescent obesity,8,11 but there is considerable evidence that obesity results in immediate and longer-term health consequences in children, and especially adolescents. These range from orthopaedic complications, sleep apnoea and hepatic steatosis to more common manifestations of cardiovascular disease risk factors, type 2 diabetes and psychosocial problems, including low self-esteem and depression.12 There are also the problems associated with the common pattern of obesity progressing into adulthood, leading to earlier development of chronic diseases such as type 2 diabetes.13 More recent data have indicated clearly that many of these ill-health consequences of excessive weight are present in children and adolescents who are defined as overweight.14 As a consequence, early intervention in overweight children and adolescents appears justified, and highlighting the extent of the problem of overweight should not be dismissed as an attempt to exaggerate the level of weight problems in children and adolescents.”

Combined effects of overweight and smoking in late adolescence on subsequent mortality: nationwide cohort study. (BMJ. 2009)

Contribution of early weight gain to childhood overweight and metabolic health: a longitudinal study (EarlyBird 36). (Pediatrics. 2009) “CONCLUSIONS: Most excess weight before puberty is gained before 5 years of age. Weight at 5 years of age bears little relation to birth weight but closely predicts weight at 9 years of age. Single measures of current weight are predictive of metabolic health, whereas weight gain within a specific period adds little. A single measure of weight at 5 years of age provides a pointer to future health for the individual. If metabolic status at 9 years of age means future risk, diabetes/cardiovascular prevention strategies might better focus on preschool-aged children, because the die seems to be largely cast by 5 years of age, and a healthy weight early in childhood may be maintained at least into puberty.”

Hispanic Children In U.S. At Greater Risk For Obesity Than Other Ethnic/Racial Groups

Is obesity associated with oxidative stress in children? (Int J Pediatr Obes. 2009)

Meal frequency, breakfast consumption and childhood obesity. (Int J Pediatr Obes. 2009) “Conclusions. High meal frequency was inversely associated with childhood obesity. This association was not explained by potential confounders or regular breakfast consumption. These findings support the hypothesis of an independent protective impact of frequent daily meals other than breakfast on childhood obesity.”

Obesity and eating disturbances are common in 15-year-old adolescents. A two-step interview study. (J Psychiatry. 2009)

Obesity and respiratory diseases in childhood. (Clin Chest Med. 2009)

Promotion and provision of drinking water in schools for overweight prevention: randomized, controlled cluster trial. (Pediatrics. 2009)

Risk Factors and Adult Body Mass Index Among Overweight Children: The Bogalusa Heart Study (PEDIATRICS 2009) “CONCLUSIONS. Overweight children vary substantially in terms of body fatness and risk-factor levels. Among these overweight children, levels of waist/height ratio are more strongly associated with adverse risk-factor levels than are levels of BMI for age or skinfold thickness.”

Timing and Tempo of First-Year Rapid Growth in Relation to Cardiovascular and Metabolic Risk Profile in Early Adulthood (JAMA. 2009) “Conclusion Rapid weight gain in the first 3 months of life is associated with several determinants of cardiovascular disease and type 2 diabetes in early adulthood. “

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