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

Risk Factors

NEWS:

2.2 Million Drop-Side Cribs Recalled

Accidental Childhood Poisonings Mostly Due To Medicines

Blinds Recalled Due to Strangulation Risk “The risk of strangulation in children has prompted the Consumer Product Safety Commission (CPSC) and the Window Covering Safety Council to issue a voluntary recall today for more than 50 million Roman-style shades and roll-up blinds.”

Chemical in plastic tied to preemie problems “A chemical used in many plastic products and already under scrutiny for potential health risks is suspected of raising the risk of liver problems in premature babies , according to a new study. The small study in a German hospital suggests a chemical known as a phthalate, used in some intravenous feeding bags and tubing, may raise preemies' chances for liver damage . Rigorous research on phthalates' effects in humans is lacking, and at least one expert found the German study unconvincing. There is no solid proof implicating the phthalate studied, DEHP. “

Child abuse 'alters stress gene' “Abuse in early childhood permanently alters how the brain reacts to stress, a Canadian study suggests. Analysis of brain tissue from adults who had committed suicide found key genetic changes in those who had suffered abuse as a child. It affects the production of a receptor known to be involved in stress responses, the researchers said. The Nature Neuroscience study underpins the impact of stress on early brain development, experts said. Previous research has shown that abuse in childhood is associated with an increased reaction to stressful circumstances. “

Baby bottle chemical is removed “The makers of babies' bottles in the US are to remove a controversial chemical from their products, amid growing concern over its possible effects. The six manufacturers say they are reacting to consumer demand by removing Bisphenol A (BPA) from their bottles. But they will continue selling bottles containing BPA in the UK, a decision which has angered campaigners. The Food Standards Agency insists BPA in UK plastic products is "well below the levels considered harmful". The chemical is widely used in plastic manufacture and is commonly found in food and drink containers. “

Childhood Abuse Associated With Onset Of Psychosis In Women

FDA Urges Consumers Not to Purchase or Use Certain Gel-Filled Teethers

Half of U.S. Kids Assaulted Each Year: Study “The survey also found that: • Nearly half the children surveyed were assaulted at least once in the past year, and more than one in 10 were injured as a result. • Nearly one-quarter of the children were the victim of a robbery, vandalism or theft. • About 10 percent were victims of maltreatment (including physical and emotional abuse, neglect or a family abduction), and one in 16 were victimized sexually. The report, Children's Exposure to Violence: A Comprehensive National Survey, was published by the Office of Juvenile Justice and Delinquency Prevention with support from the Centers for Disease Control and Prevention.”

Half of all bathtub injuries involve toddlers “The new analysis shows that children age 4 and younger accounted for more than half of all bathtub- and shower-related injuries. About 60 percent of the injuries were lacerations (cuts and tears to the skin) and more than 20 percent were sprains and other soft-tissue injuries. The most commonly affected body region was the head, accounting for nearly 50 percent of the bath injuries, followed by the head and neck, which accounted for 15 percent of the injuries. "That is because young children, the ones typically injured in bathtubs and showers, they tend to topple forward," said study team member Dr. Gary Smith, director of Center for Injury Research and Policy at Nationwide Children's Hospital in Ohio. "They have a high center of gravity, and they tend to strike their head and their face, and that ends up with injures such as lacerations." “

Household Exposure to Paint and Petroleum Solvents, Chromosomal Translocations, and the Risk of Childhood Leukemia “Conclusions: The association of ALL risk with paint exposure was strong, consistent with a causal relationship, but further studies are needed to confirm the association of ALL and AML risk with solvent exposure.”

Infant Car Seats May Lower Oxygen Levels “Leaving young infants in car seats for extended periods of time may result in low oxygen levels and put them at risk for breathing problems, according to a new study. Researchers say car seats are essential for the safe transportation of infants. But leaving an infant in an upright position for a long period of time can partially compress the chest wall, affecting airway size.”

Largest Turtle-Linked Salmonella Outbreak Detailed “Two girls who swam with pet turtles in a backyard pool were among 107 people sickened in the largest salmonella outbreak blamed on turtles nationwide, researchers report. The 2007-08 outbreak involved mostly children in 34 states; one-third of all patients had to be hospitalized. In many cases, parents didn't know that turtles can carry salmonella. Despite a 1975 ban on selling small turtles as pets, they continue to be sold illegally. … Salmonella in turtle feces can end up on their shells and body, and can spread to people who handle them. “

Lead, chemicals found in toys despite stricter law

Mental Health Problems In Childhood May Predict Later Suicide Attempts In Males “Most males who commit suicide or need hospital care for suicide attempts during their teen or early adult years appear to have high levels of psychiatric problems at age 8, according to a new report. However, later suicide attempts in females are not predicted by mental health issues at this age.”

Millions of Children In U.S. Found to Be Lacking Vitamin D “Millions of U.S. children have disturbingly low Vitamin D levels, possibly increasing their risk for bone problems, heart disease, diabetes and other ailments, according to two new studies that provide the first national assessment of the crucial nutrient in young Americans. About 9 percent of those ages 1 through 21 -- about 7.6 million children, adolescents and young adults -- have Vitamin D levels so low they could be considered deficient, while an additional 61 percent -- 50.8 million -- have higher levels, but still low enough to be insufficient, according to the analysis of federal data being released Monday. "It's astounding," said Michal L. Melamed of the Albert Einstein College of Medicine in New York, who helped conduct one of the studies published online by the journal Pediatrics. "At first, we couldn't believe the numbers. I think it's very worrisome." “

New WHO Data Underscores Global Threat Of World's Leading Child Killer: Pneumonia

Newborn weights affected by environmental contaminants “Recent epidemiological studies have revealed an increase in the frequency of genital malformations in male newborns (e.g., un-descended testes) and a decrease in male fertility. The role played by the growing presence in our environment of contaminants that reduce male hormone action could explain this phenomenon.”

Parents 'ignoring eye sun danger' “Three in four parents are risking their child's eyesight by exposing them to bright sun without appropriate protection, experts warn. Nearly a third of parents in Britain do not buy their children sunglasses, a poll of 2,000 people for the College of Optometrists revealed. Of those who do, nearly half put price before protection and only a quarter buy sunglasses from a trusted brand. The College recommends choosing dark glasses with a CE mark for quality. People with light coloured eyes are most at risk from sun damage and those with blue eyes should always wear sunglasses, the experts advise.”

People With Parents Who Fight Are More Likely To Have Mental Health Problems In Later Life

Pesticide Susceptibility In Children Lasts Longer Than Expected “"Current EPA standards of exposure for some pesticides assume children are 3 to 5 times more susceptible than adults, and for other pesticides the standards assume no difference," said Nina Holland, UC Berkeley adjunct professor of environmental health sciences and senior author of the paper. "Our study is the first to show quantitatively that young children may be more susceptible to certain organophosphate pesticides up to age 7. Our results suggest that the EPA standards need to be re-examined to determine if they are adequately protecting the most vulnerable members of the population." “

CDC: Pet Frogs Source of Salmonella Outbreak

Plastics Chemical Tied to Aggression in Young Girls “In the latest study to suggest an association between the plastics chemical bisphenol A (BPA) and adverse effects on humans, researchers report that BPA may affect the behavior of little girls. Girls exposed to higher levels of BPA displayed more "externalizing" behaviors, such as aggression and hyperactivity, according to the study, which is published in the Oct. 6 online edition of Environmental Health Perspectives. "We found almost all of the women [in the study] had detectable levels of bisphenol A in at least one of the tests, and elevated concentrations were associated with externalizing behaviors in female children," said study author Joe Braun, a graduate student and research assistant in epidemiology at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill. Not everyone agreed with the study's conclusions, however. "This type of study has no capability to establish cause and effect, only associations. At the end of the study, the authors even point out that the results 'should be viewed cautiously,'" noted Steven Hentges, executive director of the polycarbonate/BPA global group at the American Chemistry Council, which represents the chemicals industry. BPA is a commonly used chemical that's found in hard plastics and epoxy resins. The chemical is used in water bottles, food containers, infant bottles and medical devices. BPA may also be found in the lining of canned foods. Most human exposure comes through diet when the chemical leaches into food and beverages from the containers, according to the U.S. National Institute of Environmental Health Sciences. Previous studies suggest that more than 90 percent of people in the United States have detectable levels of BPA in their urine.”

Poisons on Pets “Flea control products now on the market include seven specific "organophosphate insecticides" (OPs). OPs work by blocking the breakdown of the body's messenger chemical, acetylcholine, thereby interfering with the transmission of nerve signals in the brains and nervous systems of insects, pets and humans alike. In the presence of OPs, acetylcholine builds up in the body. The resulting interference with nerve transmissions is of such a magnitude that it actually kills insects. In overdoses, OPs can also kill people and pets. But even with normal use of flea-control products containing OPs, pets and children may be in danger. The seven OPs are chlorpyrifos, dichlorvos, phosmet, naled, tetrachlorvinphos, diazinon and malathion. They are the active ingredients in dozens of pet products. A comprehensive list of products appears in Table 1. It includes major pet pesticide brands, such as Alco, Americare, Beaphar, Double Duty, Ford's, Freedom Five, Happy Jack, Hartz, Hopkins, Kill-Ko, Protection, Rabon, Riverdale, Sergeant, Unicorn, Vet-Kem, Victory and Zema. … The continued exposure of children, pets and animal workers to OPs contained in pet products is all the more distressing because safer alternatives are readily avail-able. Easy physical measures alone, like frequent washing and combing of the pet and vacuuming carpets and furniture, can bring mild flea infestations under control. Alternatives include insect growth regulators, or IGRs, which are not pesticides, but rather chemicals that arrest the growth and development of young fleas. These include methoprene, fenoxycarb and pyriproxyfen and the popular lufenuron (Program®). Alternatives also include newer pesticide products sprayed or spotted onto pets, such as fipronil (Frontline®) or imidacloprid (Advantage®). Particularly when used in combination with physical measures, the safety and effectiveness of these newer chemical products makes the continued use of pet products containing OPs -- and their attendant risks for humans and pets alike -- rash and unnecessary. … “

Probable Carcinogens Found in Baby Toiletries “Some of the biggest names on the market, including Johnson & Johnson Baby Shampoo and Baby Magic lotion, tested positive for 1,4-dioxane or formaldehyde, or both, the nonprofit Campaign for Safe Cosmetics reported. The chemicals, which the Environmental Protection Agency has characterized as probable carcinogens, are not intentionally added to the products and are not listed among ingredients on labels. Instead, they appear to be byproducts of the manufacturing process. Formaldehyde is created when other chemicals in the product break down over time, while 1,4-dioxane is formed when foaming agents are combined with ethylene oxide or similar petrochemicals. … The European Union has banned 1,4-dioxane as an ingredient in personal care products, but the Food and Drug Administration has not established a safe limit for the chemical in shampoo, lotion and other toiletries. It maintains that the trace amounts found in those products are not harmful. A 1982 study by the FDA showed that 1,4-dioxane can penetrate human skin when used in lotion. Health advocates argue, however, that federal regulators have not considered the cumulative effect of chemicals in personal care products.”

Sad Moms Equal Sleepless Babies “Women who suffer from depression before their babies are born are more likely to have infants who keep them up at night. A new study finds these infants have a harder time settling down to sleep, sleep for shorter periods of time, and take shorter daytime naps than infants whose mothers did not suffer from depression during their pregnancies. The authors believe these effects might be due to fetal exposure to the stress hormone cortisol. But that doesn’t mean these babies are irreversibly destined to sleep poorly once they are born. “

'Safe' lead levels harm children “The researchers say the toxic effects of lead on the central nervous system are obvious even below the current so-called safe level of lead in the blood. They are recommending the threshold should be halved.”

Slippery bathrooms cause many injuries in kids

Spanking Found To Have Negative Effects On Low-income Toddlers “A new longitudinal study that looks at how low-income parents discipline their young children has found that spanking 1-year-olds leads to more aggressive behaviors and less sophisticated cognitive development in the next two years. Verbal punishment is not associated with such effects, especially when it is accompanied by emotional support from moms. In addition, 1-year-olds' fussiness predicted spanking and verbal punishment at ages 1, 2, and 3.”

Studies Suggest Physicians Should Be Vigilant for Serious H1N1 Infection in Young “The pattern of the swine-origin influenza A (H1N1) virus (S-OIV) seen in March and April of this year suggests that people exposed to H1N1 strains during childhood before the 1957 flu pandemic will be relatively protected from severe illness, according to a study in the June 29 Online First issue of The New England Journal of Medicine. The study, which appears along with a case series describing some of the first patients to be hospitalized with confirmed H1N1 and pneumonia, paint a picture of the early days of the pandemic and highlight that the virus can cause serious illness in a younger population. “

Study Finds Rise in Student Injuries in Gym Class

Study confirms association between tobacco smoke and behavioral problems in children “"We were able to show that children who are exposed to tobacco smoke prenatally and during the first years of life have a higher risk of developing abnormal behavioral symptoms when they are of school age," said Dr. Joachim Heinrich of the Institute of Epidemiology at Helmholtz Zentrum München. "Moreover, it makes a difference whether the child was exposed to tobacco smoke first after birth or was already confronted with it during prenatal development." According to the study, children who were only exposed to tobacco smoke prenatally have a 1.9 times higher risk of developing abnormal behavioral symptoms in comparison to children without any exposure (change this if it is the wrong comparison). The risk for children first exposed to tobacco smoke after birth is 1.3 times higher. Furthermore, children who were exposed to tobacco smoke both while in the womb and while growing up doubled the risk of developing abnormal behavioral symptoms. Such symptoms include hyperactivity, attention deficits or problems in their relationships with peers. The results of the study were independent of affects from the social environment in which the children were growing up.”

Teens who move a lot have twice suicide risk

Virginia Child's Kidney Problems May Be Due to Melamine-Tainted Candy

Well Water Should be Tested Annually to Reduce Health Risks to Children ”"With few exceptions, well owners are responsible for their own wells," said Rogan. Private wells are not subject to federal regulations and are only minimally regulated by states. With proper care, well water is safe; however, wells can become contaminated by chemicals or pathogenic organisms. Nitrate, which comes from sewage or fertilizer, is the most common contaminant in wells. The presence of nitrates can be a problem particularly for infants under three months who can not metabolize nitrate. Water with a nitrate concentration of more than 1.0 milligrams per liter should not be used to prepare infant formula or given to a child younger than one year. The policy statement suggests using bottled water for infants when nitrate contamination is detected, or when the source of drinking water is not known. “

ARTICLES:

6 things you forgot to childproof

Recognizing Child Abuse: Slideshow

Swimming in Body Fluids

JOURNAL ARTICLES:

Associations Between Sedentary Behavior and Blood Pressure in Young Children (Arch Pediatr Adolesc Med. 2009) “Conclusions Sedentary behaviors, particularly TV viewing and screen time, were associated with BP in children, independent of body composition. Other factors that occur during excessive screen time (eg, food consumption) should also be considered in the context of sedentary behavior and BP development in children.”

Childhood Lead Poisoning Associated with Lead Dust Contamination of Family Vehicles and Child Safety Seats --- Maine, 2008 (MMWR 2009)

Confirmed moisture damage at home, respiratory symptoms and atopy in early life: a birth-cohort study. (Pediatrics. 2009)

Is Lead Dust Within Nuclear Medicine Departments a Hazard to Pediatric Patients? (J Nucl Med Technol. 2009) “Because of the penetrating ability of the radiation used in nuclear medicine, metallic lead is widely used as radiation shielding. However, this shielding may present an insidious health hazard because of the dust that is readily removed from the surfaces of lead objects. The lead dust may become airborne, contaminate floors and other nearby surfaces, and be inadvertently inhaled or ingested by patients. We determined if the quantity of lead dust encountered within nuclear medicine departments exceeded Environmental Protection Agency (EPA) standards.”

Very Low Prenatal Exposure to Lead and Mental Development of Children in Infancy and Early Childhood. Krakow Prospective Cohort Study. (Neuroepidemiology. 2009)

Vicks VapoRub Induces Mucin Secretion, Decreases Ciliary Beat Frequency, and Increases Tracheal Mucus Transport in the Ferret Trachea (Chest 2009) “VVR stimulates mucin secretion and MCTV in the LPS-inflamed ferret airway. This set of findings is similar to the acute inflammatory stimulation observed with exposure to irritants, and may lead to mucus obstruction of small airways and increased nasal resistance.”

Relation of blood pressure and body mass index during childhood to cardiovascular risk factor levels in young adults (Journal of Hypertension 2009)

Sexual Abuse and Lifetime Diagnosis of Somatic Disorders (JAMA 2009) “Conclusion Evidence suggests a history of sexual abuse is associated with lifetime diagnosis of multiple somatic disorders. “

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