Category: Paediatrics

Categories : Cardiovascular Disease PaediatricsTags : Leave a comment

Higher Blood Pressure in Childhood Linked to Earlier Adulthood Heart Disease Mortality

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Photo by Ben Wicks on Unsplash

Blood pressure matters at all ages. Children with higher blood pressure at age 7 may be at an increased risk of dying of cardiovascular disease by their mid-50s,  according to preliminary research presented at the American Heart Association’s Hypertension Scientific Sessions 2025. The study is simultaneously published in JAMA.

“We were surprised to find that high blood pressure in childhood was linked to serious health conditions many years later. Specifically, having hypertension or elevated blood pressure as a child may increase the risk of death by 40% to 50% over the next five decades of an individual’s life,” said Alexa Freedman, Ph.D., lead author of the study and an assistant professor in the department of preventive medicine at the Northwestern University’s Feinberg School of Medicine in Chicago. “Our results highlight the importance of screening for blood pressure in childhood and focusing on strategies to promote optimal cardiovascular health beginning in childhood.”

Previous research has shown that childhood blood pressure is associated with an increased risk of cardiovascular disease in adulthood, and a 2022 study found that elevated blood pressure in older children (average age of 12 years) increased the risk of cardiovascular death by middle age (average age of 46 years). The current study is the first to investigate the impact of both systolic (top number) and diastolic (bottom number) blood pressure in childhood on long-term cardiovascular death risk in a diverse group of children. Clinical practice guidelines from the American Academy of Pediatrics recommend checking blood pressure at annual well-child pediatric appointments starting at age 3 years.

“The results of this study support monitoring blood pressure as an important metric of cardiovascular health in childhood,” said Bonita Falkner, MD, FAHA, an American Heart Association volunteer expert. “Moreover, the results of this study and other older child cohort studies with potential follow-up in adulthood will contribute to a more accurate definition of abnormal blood pressure and hypertension in childhood.” Falkner, who was not involved in this study, is emeritus professor of paediatrics and medicine at Thomas Jefferson University.

The researchers used the National Death Index to follow up on the survival or cause of death as of 2016 for approximately 38,000 children who had their blood pressures taken at age 7 years as part of the Collaborative Perinatal Project (CPP), the largest US study to document the influence of pregnancy and post-natal factors on the health of children. Blood pressure measured in the children at age 7 years were converted to age-, sex-, and height-specific percentiles according to the American Academy of Pediatrics clinical practice guidelines. The analysis accounted for demographic factors as well as for childhood body mass index, to ensure that the findings were related to childhood blood pressure itself rather than a reflection of children who were overweight or had obesity.

After follow-up through an average age of 54 years, the analysis found: 

  • Children who had higher blood pressure (age-, sex-, and height-specific systolic or diastolic blood pressure percentile) at age 7 were more likely to die early from cardiovascular disease as adults by their mid-50s. The risk was highest for children whose blood pressure measurements were in the top 10% for their age, sex and height.
  • By 2016, a total of 2,837 participants died, with 504 of those deaths attributed to cardiovascular disease.
  • Both elevated blood pressure (90-94th percentile) and hypertension (≥ 95th percentile) were linked with about a 40% to 50% higher risk of early cardiovascular death in adulthood.
  • Moderate elevations in blood pressure were also important, even among children whose blood pressure was still within the normal range. Children who had blood pressures that were moderately higher than average had a 13% (for systolic) and 18% (for diastolic) higher risk of premature cardiovascular death.
  • Analysis of the 150 clusters of siblings in the CPP found that children with the higher blood pressure at age 7 had similar increases in risk of cardiovascular death when compared to their siblings with the lower blood pressure readings (15% increase for systolic and 19% for diastolic), indicating that their shared family and early childhood environment could not fully explain the impact of blood pressure.

“Even in childhood, blood pressure numbers are important because high blood pressure in children can have serious consequences throughout their lives. It is crucial to be aware of your child’s blood pressure readings,” Freedman said.

The study has several limitations, primarily that the analysis included one, single blood pressure measurement for the children at age seven, which may not capture variability or long-term patterns in childhood blood pressure. In addition, participants in the CPP were primarily Black or white, therefore the study’s findings may not be generalisable to children of other racial or ethnic groups. Also, children today are likely to have different lifestyles and environmental exposures than the children who participated in the CPP in the 1960s and 1970s.

Study details, background and design:  

  • 38 252 children born to mothers enrolled at one of 12 sites across the U.S. as part of the Collaborative Perinatal Project between 1959-1965. 50.7% of participants were male; 49.4% of mothers self-identified as Black, 46.4% reported as white; and 4.2% of participants were Hispanic, Asian or other groups.
  • This analysis reviewed blood pressure taken at age 7, and these measures were converted to age-, sex-, and height-specific percentiles according to the American Academy of Pediatrics Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents.
  • Survival through 2016 and the cause of death for the offspring of CPP participants in adulthood were retrieved through the National Death Index.
  • Survival analysis was used to estimate the association between childhood blood pressure and cardiovascular death, adjusted for childhood body mass index, study site, and mother’s race, education and marital status.
  • In addition, the sample included 150 groups of siblings, and the researchers examined whether the sibling with higher blood pressure was more likely to die of cardiovascular disease than the sibling with lower blood pressure. This sibling analysis allowed researchers to ask how much shared family and early childhood factors might account for the mortality risk related to blood pressure.  

Source: American Heart Association

Categories : Antibiotics PaediatricsTags :

Study Suggests No Link Between Antibiotic Exposure and Autoimmune Diseases in Children

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Korean children with early life exposure to antibiotics were not diagnosed with autoimmune diseases at higher rates

Photo by Chayene Rafaela on Unsplash

The global incidence of autoimmune diseases among children has increased over the past few decades. A study published August 21st in the open-access journal PLOS Medicine by Ju-Young Shin at Sungkyunkwan University, Republic of Korea, and colleagues suggests that early life antibiotic exposure is not associated with an increased risk of autoimmune diseases in children.

Previous research has suggested that exposure to antibiotics as a foetus or infant may contribute to the development of autoimmune diseases among children. However, confounding variables limit the validity of prior studies and the association of antibiotics to autoimmune disease remains poorly understood.

In order to investigate whether antibiotics may increase risk of autoimmune diseases, researchers conducted a retrospective cohort study comprised of over 4 million children born in the Republic of Korea between April 1, 2009, and December 31, 2020. They accessed a mother-child linked insurance claims database from the South Korea National Health Insurance Service-National Health Insurance Database (NHIS-NHID) to identify children whose mothers had received antibiotic prescriptions during pregnancy or while breastfeeding their infant. The researchers then retrospectively analysed the health outcomes of each cohort for a period of over 7 years, tracking all diagnoses of Type 1 diabetes, Juvenile idiopathic arthritis, Inflammatory bowel disease (ulcerative colitis, Crohn’s disease), Systemic lupus erythematosus, and Hashimoto’s thyroiditis.

The researchers found no relationship between antibiotic exposure during pregnancy or early infancy and the overall incidence of autoimmune diseases in children. Future research is needed, however, to replicate the outcomes in other populations and to further investigate potential effects on subgroups.

According to the authors, “Our findings suggest no association between antibiotic exposure during the prenatal period or early infancy and the development of autoimmune diseases in children. This observation contrasts with several previous studies reporting increased risks and underscores the importance of carefully considering the underlying indications for antibiotic use and genetic susceptibility when interpreting such associations. While the potential benefits of antibiotic treatment in managing infections during pregnancy or early infancy likely outweigh the minimal risk of autoimmune outcomes, our findings also highlight the need for cautious and clinically appropriate use of antibiotics during these critical developmental periods in specific subgroups.”

The authors note, “Exposure to antibiotics during pregnancy or early infancy was not associated with an increased risk of autoimmune diseases in children. Nevertheless, the importance of follow-up studies to confirm and extend these findings cannot be overstated.”

Provided by PLOS

Categories : HIV PaediatricsTags :

Gene Therapy Shot at Birth May Shield Children from HIV for Years

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Colourised transmission electron micrograph of an HIV-1 virus particle (yellow/gold) budding from the plasma membrane of an infected H9 T cell (purple/green).

A new study in Nature shows that delivering a single injection of gene therapy at birth may offer years-long protection against HIV, taking advantage of a critical window in early life that could reshape the fight against paediatric infections in high-risk regions.

This study is among the first to show that the first weeks of life, when the immune system is naturally more tolerant, may be the optimal window for delivering gene therapies that would otherwise be rejected at older ages.

“Nearly 300 children are infected with HIV each day,” said first author Amir Ardeshir, associate professor of microbiology and immunology at the Tulane National Primate Research Center, who conducted the study alongside fellow researchers at the California National Primate Research Center. “This approach could help protect newborns in high-risk areas during the most vulnerable period of their lives.” 

“This is a one-and-done treatment that fits the critical time when these mothers with HIV in resource-limited areas are most likely to see a doctor.”

Amir Ardeshir

In the study, nonhuman primates received a gene therapy that programs cells to continuously produce HIV-fighting antibodies. Timing proved critical to the one-time treatment offering long-term protection.

Those that received the treatment within their first month of life were protected from infection for at least three years with no need for a booster, potentially signifying coverage into adolescence in humans. In contrast, those treated at 8–12 weeks showed a more developed, less tolerant immune system that did not accept the treatment as effectively.

“This is a one-and-done treatment that fits the critical time when these mothers with HIV in resource-limited areas are most likely to see a doctor,” Ardeshir said. “As long as the treatment is delivered close to birth, the baby’s immune system will accept it and believe it’s part of itself.”

More than 100 000 children acquire HIV annually, primarily through mother-to-child transmission after birth from breastfeeding. Antiretroviral treatments have shown success in suppressing the virus and limiting transmission. However, adherence to treatment and access to doctors both decline after childbirth, particularly in areas with limited access to healthcare.

To deliver the treatment, researchers used an adeno-associated virus (AAV), a harmless virus that can act as a cargo truck to deliver genetic code to cells. The virus was sent to muscle cells, unique in their longevity, and delivered instructions to produce broadly neutralising antibodies, or bNAbs, which are capable of neutralising multiple strains of HIV.

This approach solved a longstanding problem with bNAbs. Previous studies found them effective at fighting HIV, but they required repeated infusions, which are costly and pose logistical challenges in low-resource settings.

“Instead, we turn these muscle cells – which are long-lived – into micro factories that just keep producing these antibodies,” Ardeshir said.

Newborns showed greater tolerance and expressed high levels of bNAbs, which successfully prevented infection, while older infants and juveniles were more likely to have produced anti-drug antibodies that shut down the treatment.

Researchers also found that exposing fetuses to the antibodies before birth helped older infants accept the gene therapy later, avoiding the immune rejection that often occurs with age.

Still, Ardeshir said a one-time injection at birth offered a more cost-effective and feasible real-world solution, while putting less burden on the mother for a follow-up visit.

Questions remain as to how the results translate to human infants and children, who may be less susceptible to AAV-delivered treatments. The study also used one strain of simian–human immunodeficiency virus, which doesn’t reflect the variety of HIV strains.

If successful, however, this treatment could dramatically reduce mother-to-child HIV transmission rates in high-risk regions such as sub-Saharan Africa, where 90% of paediatric HIV cases can be found. It may also be adapted to protect against other infectious diseases like malaria, which disproportionately affects young children in low-income countries.

“Nothing like this was possible to achieve even 10 years ago,” Ardeshir said. “This was a huge result, and now we have all the ingredients to take on HIV.”

Source: Tulane University

Categories : Antibiotics PaediatricsTags :

Probiotics for Preterm Babies Lowered Antibiotic-resistant Bacteria in the Gut

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Photo by Hush Naidoo on Unsplash

Preterm babies with very low birth weight who received a probiotic alongside antibiotics had fewer multidrug resistant bacteria and a more typical gut microbiome, a new study shows.

The paper published in Nature Communications is the result of a trial testing probiotics among a group of 34 pre-term babies born with a very low birth weight, under 1500g representing around 1-1.5% of babies born around the world. The study sequenced gut bacteria from the babies during the first three weeks after birth.

The collaborative study led by Professor Lindsay Hall and Dr Raymond Kiu from the University of Birmingham found that among babies who received a probiotic treatment of a certain strain including Bifidobacterium alongside antibiotics, levels of typical bacterial strains associated with early-life gut microbiota were at levels typical among full-term babies, reducing both the abundance of antibiotic resistance genes and the number of multi-drug resistant bacteria in the gut.

In the context of the global AMR crisis, this is a major finding, especially for NICUs where preterm infants are especially vulnerable. Probiotics are now used in many neonatal ICUs around the UK, and the WHO have recommended probiotic supplementation in preterm babies. Our paper shows how beneficial this intervention can be for babies born prematurely to help them give their gut a kickstart, and reduce the impact of concerning pathogens taking hold.Professor Lindsay Hall – University of Birmingham

There were lower levels of drug-resistant pathogens including Enterococcus associated with risks of infections and longer hospital stays. Babies who received probiotics also saw higher levels of certain positive bacteria found naturally in the gut.

Among babies who didn’t receive probiotics, analysis of the gut bacteria found that while some differences occurred between those receiving antibiotics or not, both groups saw a dominant microbiome develop that included key bacteria (pathobionts) that can cause health problems including life-threatening infections during the crucial period after birth, as well as in later life.

Professor Lindsay Hall from the University of Birmingham and a group leader at Quadram Institute Bioscience, and senior corresponding author of the study said: “We have already shown that probiotics are highly effective in protecting vulnerable preterm babies from serious infections, and this study now reveals that these probiotics also significantly reduce the presence of antibiotic resistance genes and multidrug-resistant bacteria in the infant gut. Crucially, they seem to do so selectively – targeting resistant strains without disrupting non-resistant strains that might be beneficial.

“In the context of the global AMR crisis, this is a major finding, especially for NICUs where preterm infants are especially vulnerable. Probiotics are now used in many neonatal ICUs around the UK, and the WHO have recommended probiotic supplementation in preterm babies.

“Our paper shows how beneficial this intervention can be for babies born prematurely to help them give their gut a kickstart, and reduce the impact of concerning pathogens taking hold.”

Dr Raymond Kiu from the University of Birmingham, first and co-corresponding author of the paper said: “Sequencing technology has now confirmed that probiotic Bifidobacterium rapidly replicates in the preterm gut during the first three weeks of life. Importantly, this successful colonisation drives the maturation of the gut microbiota and is linked to a noticeable reduction in multi-drug-resistant pathogens – pointing to its pivotal role in improving neonatal health. Our findings also shed light on the complex interactions between antibiotics, probiotics, and horizontal gene transfer (HGT) in shaping the early-life microbiome.

“We believe this research lays the groundwork for future studies exploring the role of probiotics in antimicrobial stewardship and infection control among preterm populations.”

Source: University of Birmingham

Categories : General Interest PaediatricsTags :

“I Looked at Those Tiny Feet”: How a Joburg Mother’s Journey Helped Thousands of Children Walk Without Pain

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Dr Saul Kaplan (left) stands next to Dr Kenny Beck, with mother Zukiswa Panyaza as her baby receives a full leg cast at the clubfoot clinic in Tygerberg Hospital’s Division of Orthopedic Surgery, while medical students observe. (Photo: Sue Segar/Spotlight)

By Sue Segar

When Karen Mara Moss’s son was diagnosed with clubfoot, she travelled to the US in search of a life-changing treatment. She made a promise to bring it home and two decades on, her non-profit is at the heart of a remarkable success story.

“I looked at those tiny feet. They were turned over and rigidly pointing inwards,” recalls Karen Mara Moss about the day her son Alex was born in 2003.

For her, the memory is as vivid today as it was then. Within moments of his birth, a concerned obstetrician commented on Alex’s feet. Then the paediatrician diagnosed Alex with bilateral clubfoot, a condition in which a baby is born with one or both feet twisted inward and downward.

“I remember thinking: Will he walk with a limp? Will people mock him?” Moss tells Spotlight. “It was a traumatic time.”

She says the paediatrician told her not to worry. “He said they’d have to cut his feet and straighten them, and it would all be perfect,” says Moss.

Despite having several prenatal scans and tests, the condition had not been picked up before birth.

The most common form of clubfoot present at birth is idiopathic clubfoot, medically known as talipes equinovarus. It is when a baby’s foot is pointed in and down because the tissues connecting the muscles to the bone are shorter than usual, leading to pain and reduced mobility if left untreated, according to a review study published in The Lancet medical journal. In most cases, the cause of this congenital anomaly which ranges from mild to severe, is unknown, baby boys are twice as likely to be born with clubfoot as baby girls, and about half of children with clubfoot have it in both feet. Globally, an estimated 176 000 babies are born with the condition every year.

Eight days after Alex was born, Moss says she met with a paediatric orthopaedic surgeon. She says he told her he’d fixed many clubfeet using the Kite method and even had one patient playing first-team rugby. The Kite method was developed in the 1930s and uses manipulations and castings to achieve a sequential and gradual full correction of the forefoot, then the hindfoot, and finally, the ankle. After the casting is done, the baby wears a special splint to keep the feet pointing slightly outward and upward, but, critically, many would also require further surgery.

Back then, the standard of care for clubfoot was surgical management, says Dr Pieter Maré, an orthopaedic surgeon who heads up the clubfoot clinic at Greys Hospital in Pietermaritzburg, Kwazulu-Natal. “The reality was that a large number of children required extensive surgery before the Ponseti method,” he says.

Moss followed the doctor’s advice, and during that first appointment, she says he began applying casts up to Alex’s knees. “He started wrenching Alex’s foot, holding the back, whilst pushing the front of the foot, and plastering the foot. Alex was blue in the face from screaming. I was crying while holding him down,” she says.

Another way

But after two months and seven casts, she says there was little improvement in Alex’s feet. That is when Moss began searching for answers herself. Doing research on the internet, she discovered the University of Iowa Children’s Hospital website, where she read about a technique developed by Dr Ignacio Ponseti, which he claimed could help children have pain-free, functional feet without surgery.

The Ponseti method was developed in the 1950s but only became more widely used in the United States in the 1990s, and later in much of the rest of the world. The technique uses gentle manipulations and plaster casts to correct the midfoot, hindfoot, and forefoot simultaneously, while the ankle is treated afterwards. In some cases, before the last cast is applied, it may require a percutaneous tenotomy which is a minimally invasive procedure to cut the heel cord that is resistant to stretching. A brace is then fitted the same day as the last cast is taken off.

“The Kite method was developed to correct clubfoot but over time it was realised that this method was using the wrong anatomical methods,” explains Professor Anria Horn, a consultant orthopaedic surgeon at the Red Cross Children’s Hospital in Cape Town.

“There are multiple joints in the foot and the Kite method was, effectively, manipulating the wrong joint in an attempt to bring about the correction in the foot. Ponseti discovered that the manipulation should occur at a different joint,” she says.

Back in 2003, Moss emailed Ponseti, and a few days later called his office. “I was put through to a man with a Spanish accent. He said he’d read my email, and that he’d seen the photos I sent of my son’s feet; that what we’d done was not the way his method worked. He suggested I go to Iowa because nobody in South Africa was practising his method,” she says.

Not long after this, Moss and her husband travelled with ten-week-old Alex for 10 000 miles from sunny South Africa to an unseasonable snowstorm in Iowa.

The idea of travelling to a foreign country to see a “special” doctor that one read about on the internet, with a treatment carrying his name, may raise red flags for some. There are after all no shortage of quacks out there exploiting vulnerable people with just this type of story of an underutilised treatment. Ponseti, however, was a serious scientist and, even by 2003, his method had performed well in several studies and had been quite widely adopted by doctors in the United States.

Moss says in that first visit, Ponseti eventually did a cast all the way up Alex’s leg. “He looked like a little turtle with his legs sticking out. By the time he’d done the second cast, Alex was asleep,” Moss recalls.

“Dr Ponseti’s normal protocol was to remove the cast every week, then re-manipulate the foot into a different position, and reapply the cast. For out-of-town patients, he accelerated the treatment and changed the cast every five days,” she adds.

After just one cast, Alex’s foot looked different, says Moss. “They did another cast, and five days later, it was time for the third cast. Dr Ponseti took the second cast off and then did the percutaneous tenotomy, as well as the third and final cast.”

After this procedure and with Alex now in his final casts, they were told they could return to South Africa and take the casts off three weeks later. Moss said an orthotist measured Alex’s feet before the tenotomy and gave her instructions on how to fit the clubfoot brace he would wear for four years while sleeping.

Three weeks later, back home, Moss soaked the casts off and started to put the brace on at night. She says Alex’s feet were straight.

‘A parting gift’

On her final day in Iowa, Moss recalls Ponseti telling her: “You’re the first South African that’s ever been here. Please go back home and tell the doctors not to operate on clubfoot”. He gave her his book, copies of his research papers, and CDs demonstrating his casting method – a parting gift that would shape the course of her life.

Determined to share her what she had learnt, Moss created a website to provide information on clubfoot. The website gained traction and soon she started getting requests from parents across southern Africa for help to access the Ponseti method.

At the time, Moss says she knew of only one doctor using the method, whom she recommended parents consult. “I’d met him soon after my return to South Africa in 2003 and had lent him Dr Ponseti’s book and papers. He’d then gone to the US to attend a Ponseti training workshop and started using the method. I was sending everyone to him.”

The founding of STEPS

Moss realised the best solution was to bring the training directly to South Africa. In 2005, despite having no experience in running a non-profit organisation, she founded STEPS, driven by her commitment to introduce the Ponseti method across the country.

Moss says STEPS held its first two-day Ponseti training course in 2006, with about 60 paediatric orthopaedic surgeons attending. “Three Ponseti experts came from Canada, Brazil and the UK to give the training. They taught a lot of theory and used bone models to demonstrate the method,” she says.

The second STEPS Ponseti workshop in 2007 focused on public health facilities. Moss says the training took place at the Charlotte Maxeke Johannesburg Academic Hospital.

Partly due to the workshops, partly due to the strength of the accumulating scientific evidence, the method caught on in the country. In 2012, the South African Paediatric Orthopaedic Society officially endorsed the method. A Cochrane Review published in the same year found that, while the available evidence was far from complete, it did indicate that the method works well. Cochrane Reviews are a highly regarded type of study that attempts to assess evidence from all randomised clinical trials relating to a specific medical question.

“The Ponseti method has become the gold standard for the treatment of idiopathic clubfoot,” stated an article published in the World Journal of Orthopedics in 2014. And according to the Lancet study cited earlier, “the Ponseti method is widely recognised as an effective conservative treatment approach for clubfoot that avoids corrective surgery in over 90% of cases”.

Today, Horn says the Kite method isn’t used in South Africa any more, having been replaced by the Ponseti method. “STEPS has played a big part in promoting the Ponseti method in South Africa, as well as providing training, workshops and conferences and supporting clubfoot clinics across the country. Our job would have been much harder without the support that STEPS provides,” she adds.

Ponseti in the public sector

Given the equipment and know-how involved, making the Ponseti method available in South Africa’s public sector was a challenge. In 2013, Moss launched a support programme to help government clinics offer the treatment. STEPS began by partnering with just six clinics. With support from donors, they recruited staff to visit each clinic weekly to guide families or trained someone on-site to do so. They also provided educational materials to help raise awareness. Over time, this led to STEPS helping develop standard systems and processes for running the clinics, making care more consistent and accessible. When some clinics couldn’t provide braces, STEPS arranged for it to be donated.

Today, STEPS has 48 partner clinics across South Africa, ranging from a tiny rural clinic in Lusikisiki in the Eastern Cape to bigger clinics in Gauteng and the Western Cape. “Lusikisiki might see three patients a week, and Chris Hani Baragwanath Academic Hospital could see 80. They all open once a week, except for some small, rural clinics,” Moss says.

Based on stats that STEPS collected, Moss estimates that at least 2 000 children are born every year with clubfoot in South Africa. Through the help of her organisation, she says: “More than 20 500 children have accessed effective treatment. We’ve … distributed 22 628 clubfoot braces. In 2024, we supported 4 592 children at partner clinics in different stages of the four-year treatment protocol.”

Moss adds that STEPS has conducted over 20 training sessions across South Africa, Namibia, Botswana, and the Seychelles, with more than 2 000 healthcare professionals. “Parents were bringing their children over the border as they couldn’t access treatment back home. We worked with the ministries of health in those countries to teach the Ponseti method there,” she says.

Though separated by an ocean, Moss says she stayed in close contact with Ponseti. She says the last time they saw each other was at a clubfoot symposium in Iowa in 2007. Two years later, he passed away at the age of 95.

“I felt as if I’d lost a member of my family,” Moss says. “He was the master, and he inspired me in my work to improve the lives of children born with clubfoot.” She said she would always carry the ache of missing him, but bringing his method to South Africa, just as she had promised, was something that gave her a deep sense of purpose and peace.

That promise, purpose and peace started with Alex who is today in his final year of a Bachelor of Commerce degree and who, in his own words, “enjoys being active outdoors with my friends”, likes playing padel, and going on hikes.

*This article is part of Spotlight’s 2025 Women in Health series, featuring the remarkable contributions of women to healthcare and science.

Republished from Spotlight under a Creative Commons license.

Read the original article

Categories : PaediatricsTags :

Flawed Advice on Drug Safety is Pushing Women to Stop Breastfeeding – New Study

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The evidence supporting the health benefits of breastfeeding is overwhelming, yet many women taking medicines are advised to stop, often unnecessarily.

Photo by Lucy Wolski on Unsplash

The evidence supporting the health benefits of breastfeeding is overwhelming, yet many women taking medicines are being advised to stop, often unnecessarily, according to a new study from the University of Bath.

The research, led by scientists in the Department of Life Sciences at Bath, reveals that concerns about drug safety during breastfeeding are a significant factor in the decision to stop, yet many medications prompting women to stop breastfeeding have either been found to cause no harm in limited studies, or the potential risks to the infant are considered minimal and outweighed by the benefits to the mother.

The new study, published today in the International Breastfeeding Journal, found that up to 18% of women who need a medication stopped breastfeeding due to that medication, rising to up to 58% among those with chronic illnesses.

These findings were supported by a Public Health England survey of 500 UK mothers, where 71% of respondents agreed with the statement, “It (breastfeeding) could prevent me from taking medication.”

The Bath study reviewed research from seven countries across Europe and the USA spanning the past two decades. It was inspired by the researcher’s personal experience as a breastfeeding mother and pharmacist, which led her to undertake a PhD at the University of Bath.

“I suspected the advice I was getting wasn’t right,” said Rachel Pilgrim. “I felt quite nervous challenging the doctor – even though, as a pharmacist, it’s usually part of my job to do that, it felt very different as a patient. But the experience made me think – what it is like for women who don’t feel able to speak up?”

Breastfeeding is widely recommended by health authorities the world over. In the UK, exclusive breastfeeding is advised for the first six months of life, with continued breastfeeding alongside solid foods until at least one year.

Yet, despite widespread promotion of breastfeeding, the UK continues to report some of the lowest breastfeeding rates in Europe. While nearly half of mothers (49%) are breastfeeding at 6-8 weeks after giving birth, only 1% breastfeed exclusively to six months, according to a 2010 UK survey.

International surveys have found that exclusive breastfeeding at six months is reported in 27.2% of infants in the USA, 38% in Canada, and 37.5% in Australia.

The evidence gap

The maternal use of medication during breastfeeding does require caution, as some drugs can pass into breastmilk and affect the baby. However, for many medications, the amount transferred is minimal and unlikely to cause harm.

One problem lies in the lack of clinical trial data, as breastfeeding women are typically excluded from pharmaceutical trials due to the ethical implications of exposing a baby to an untested drug. Information on the effects of a medicine during breastfeeding builds slowly once a new drug starts to be used.

However, key medicines information resources for clinicians, such as the British National Formulary (BNF), often advise against drug use during breastfeeding, not because the medicine is definitely unsafe, but because its effects are not known with certainty. This conservative stance can lead to overly cautious or even incorrect advice. The study found that even for common medications such as antidepressants and painkillers – where safety data is well-established – women are stopping breastfeeding.

“The BNF is the first place most professionals look, but it doesn’t always reflect the full picture,” said Ms Pilgrim.

“As a result, the advice given to women is often incorrect. And even when the safety data is more limited, women need to be given accurate, balanced information that considers both the risks of the medication and the benefits of continued breastfeeding.”

Real-world impact

An evaluation of the Drugs in Breastmilk Service, run by the UK-based Breastfeeding Network, has found that 21% of mothers who contacted the service had been advised to stop breastfeeding by a healthcare professional. In 98% of these cases, this advice was found to be incorrect, and the women could have safely continued breastfeeding.

Alarmingly, fewer than 6% of these women were referred to the service by a healthcare provider – most found it through social media or peer support groups.

This disconnect between available evidence and clinical practice is contributing to unnecessary breastfeeding cessation, says Ms Pilgrim.

Both Ms Pilgrim and Dr Matthew Jones – who co-authored and supervised the study – are sympathetic towards clinicians who err on the side of caution when prescribing to breastfeeding mothers.

Dr Jones, an academic and pharmacist in the Department of Life Sciences at Bath, said: “Double checking the ‘conservative’ advice found in the BNF is highly time consuming.

“In my previous job as an NHS medicines information specialist, I might spend two hours verifying the safety of a drug using more specialist resources. Most people don’t have that kind of time.”

Study co-supervisor Dr Sarah Chapman from King’s College London, added: “We know breastfeeding women frequently choose not to take safe, beneficial medications because of misinformation and worries about effects on their baby; this study shows women also stop breastfeeding unnecessarily.”

Plans to improve safety awareness

Ms Pilgrim will build on her study through a three-phase PhD research project due to start in September and funded by Pharmacy Research UK.

As part of this work, she will develop a resource to make it easier for people to access specialist advice on breastfeeding. This will either be aimed at healthcare professionals or at women themselves.

Her goal is to improve communication between healthcare professionals and women, raise awareness that most drugs are safe to take when breastfeeding and ultimately support more women to continue feeding their babies while taking essential medications.

Source: University of Bath

Categories : PaediatricsTags :

How Much Infants Cry is Mostly Down to Genetics

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Photo by William Fortunato

How much an infant cries is largely steered by their genetics and there is probably not much that parents can do about it. This has been shown in a new Swedish twin study from Uppsala University and Karolinska Institutet in which researchers investigated how genetics and environment influence infants’ crying duration, sleep quality and ability to settle during the first months of life.

The study, which was recently published in JCPP Advances, is based on questionnaire responses from parents of 1000 twins spread across Sweden. The parents were asked questions about their children’s sleep, crying and ability to settle when the twins were two months old and then again at five months old. The researchers were interested in finding out how genetics and environment influence these behaviours during the first months of life – something that no study has done before.

The clearest results were seen when the researchers analysed how long the children cried per day.

“What we found was that crying is largely genetically determined. At the age of two months, the children’s genetics explain about 50 per cent of how much they cry. At five months of age, genetics explain up to 70% of the variation. For parents, it may be a comfort to know that their child’s crying is largely explained by genetics, and that they themselves have limited options to influence how much their child cries,” says Charlotte Viktorsson, postdoctoral fellow in psychology and lead author of the study.

The parents who participated in the study were asked how long their children cried, how often they woke up at night, and how long it took until they settled. There was large individual variation between the children. For example, some children could wake up a total of up to 10 times per night. The figures below show averages.

2 months:
Crying duration (per 24 hours): about 72 minutes
Wakeups: 2.2 times per night
Time until settled: about 20 minutes

5 months:
Crying duration (per 24 hours): about 47 minutes
Wakeups: 2.1 times per night
Time until settled: about 14 minutes

The remaining percentage that cannot be explained by genetics was explained by what the researchers call ‘unique environment’ – factors in the children’s environment or life situation that are unique to each child and cannot be identified precisely from the questionnaire responses.

Charlotte Viktorsson is the lead author of the study that investigated how genetics and environment influence infants’ crying, sleep, and ability to settle during the first months of life. Photo: Mikael Wallerstedt

Twin studies reveal the importance of genetics

The participants were recruited by letter, which was sent to families with twins aged 1–2 months. These families were identified from the population register. To be able to capture how much of a behaviour is genetically determined, the researchers compared identical (monozygotic) twins with fraternal (dizygotic) twins. The advantage of studying twins is that they share important factors such as home environment, family situation, and socio-economic status. If identical twins become more similar to each other than fraternal twins in terms of a certain trait, such as how much they cry, it is seen as an expression of the importance of genetics for that trait.

The environment plays a role in infants’ time until settled

Using the same method, the researchers also analysed the number of times the children woke up at night. Here, genetics played less of a role. The number of awakenings during the night was mainly influenced by environmental factors, which can include sleep routines and the environment in which the child sleeps

In the questionnaire, the parents were also asked to state how long it took from the child being put to bed until they were asleep.

“How rapidly the infant settles was primarily due to the environment at 2 months of age, but by 5 months, their genetics had gained some significance. This reflects the rapid development that occurs in infants, and may indicate that parents’ efforts in getting their child to settle may have the greatest impact in the first months,” says Charlotte Viktorsson, who led the study.

However, it is difficult to draw conclusions about which interventions are effective based on this type of observational study.

“Although we cannot see which specific environmental factors influence the number of awakenings during the night, or how long it takes until the child settles, this study points out a direction for future studies with a focus on sleep routines,” she says.

The researchers have followed the twins up to 36 months of age, allowing them to see how sleep and crying change as the children get older. The current study is thus the first in order based on this data.

Source: Uppsala University

Categories : Paediatrics VaccinesTags :

Can African Countries Meet 2030 Childhood Immunisation Goals?

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Researchers analysed 1 million records from national health surveys in 38 African countries and found progress in childhood immunisation coverage – but many countries, including South Africa, may still fall short of global targets

Maps of childhood immunisation coverage in African countries at regional level for 2020.

Image credit: Nguyen PT et al., 2025, PLOS Medicine, CC-BY 4.0

In the last two decades, childhood immunisation coverage improved significantly across most African countries. However, at least 12 countries, including South Africa, are unlikely to achieve global targets for full immunisation by 2030, according to a new study published July 29th in the open-access journal PLOS Medicine by Phuong The Nguyen of Hitotsubashi University, Japan, and colleagues.

Vaccines are one of the most effective ways to protect children from deadly diseases, yet immunisation coverage is still suboptimal in many African countries. Monitoring and progress in childhood immunisations at the national and local level is essential for refining health programmes and achieving global targets in these countries.

In the new study, researchers used childhood immunisation data contained in approximately 1 million records from 104 nationally representative Demographic and Health Surveys (DHS) conducted in 38 African countries between 2000 and 2019. Using modelling techniques, they estimated immunisation coverage trends through 2030 and assessed disparities across geographic regions and between socioeconomic groups.

The data showed overall improvements in immunisation coverage between 2000 and 2019. It forecast that, if current trends continue, most countries are projected to meet or exceed targets for achieving 80% or 90% coverage of vaccines against tuberculosis, measles, polio, diphtheria, pertussis (whooping cough), and tetanus. However, 12 of 38 countries are not on track to meet full immunisation goals, including high-development nations like South Africa, Egypt, and Congo Brazzaville. The study also pinpointed significant socioeconomic inequalities in coverage, with gaps in coverage of up to 58% between wealth quintiles. While these disparities were present across all countries, most are projected to shrink by 2030 –except in Nigeria and Angola, where inequalities are expected to persist or grow.

“These achievements are likely the result of sustained progress driven by decades of national and sub-national initiatives along with international support aimed at prioritising immunisation,” the authors say. “However, progress towards full immunisation coverage remains slow in 12 African countries examined. In most African nations, challenges related to vaccine affordability, accessibility, and availability remain major obstacles, driven by weak primary healthcare systems and limited resources.”

The authors add, “This study shows that while childhood immunisation coverage has improved in Africa, progress is uneven. Many countries and regions remain off track to meet global targets by 2030.”

The authors conclude, “Conducting this study reinforced how critical reliable sub-national data is for identifying communities being left behind. We hope the findings will help inform more equitable and targeted immunisation strategies.”

Provided by PLOS

Categories : Allergies PaediatricsTags :

Eliminating the Risk of Anaphylaxis from Children’s Peanut Allergy Desensitisation

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Photo by Corleto on Unsplash

Oral immunotherapy helps many children with peanut allergy – but for some, it can also trigger severe allergic reactions. In the journal Allergy, a team led by Young-Ae Lee explains what might be behind these differences and how treatment could become more personalised.

Peanut allergy is one of the most common – and most dangerous – food allergies. Tiny amounts of the protein-rich legumes can be enough to cause allergic reactions like itching and swelling, or even life-threatening anaphylaxis. For a long time, the only solution was to avoid peanuts as vigilantly as possible. Since many foods may contain traces of peanuts, that’s still a major challenge, especially for parents of affected children. Emergency medication must always be close at hand.

Recently, oral desensitisation has become available for children with peanut allergies. “Some children respond well to this treatment, but others don’t benefit at all,” says Professor Young-Ae Lee, Group Leader of the Molecular Genetics of Allergic Diseases lab at the Max Delbrück Center. “In some cases, the therapy – based on gradually increasing doses of peanut allergens – can even trigger anaphylactic reactions.”

A team led by Lee and Professor Kirsten Beyer, Head of the Pediatric Allergy Clinical Research Center at Charité – Universitätsmedizin Berlin, has now investigated why children respond so differently to the therapy and how to make it safer and more effective. Their study, published in “Allergy,” was led by first author Dr Aleix Arnau-Soler, a scientist in Lee’s lab. “We looked for molecular changes in the immune systems of children undergoing oral immunotherapy ¬– and we found them,” explains Arnau-Soler.

Gut immune cells play a key role

For their study, the researchers analyzed blood samples from 38 children, with an average age of seven, who were undergoing oral desensitization for peanut allergy at Charité. The team measured levels of immunoglobulins, which are allergy-related antibodies, and cytokines, which are inflammatory messengers, before and after therapy. 

Our results open the door to personalised approaches to treating peanut allergy – which affects three per cent of all children in industrialised countries – more effectively and safely in the future.

Young-Ae LeeHead of the “Molecular Genetics of Chronic Inflammation and Allergic Disease” lab

They also assessed how much peanut protein each child could tolerate before and after treatment – essentially, how successful the desensitization was. To delve deeper, they used modern omics technologies to identify which genes in the children’s immune cells were activated when they were exposed to peanut proteins in the lab.

“Children who responded well to the therapy already had a less reactive immune system before treatment began. Their blood showed lower levels of immunoglobulins and cytokines,” explains Arnau-Soler. These findings could help identify in advance which children are most likely to benefit from desensitization – and those who are at higher risk of side effects.

The team also found consistent differences in gene expression and DNA methylation patterns between children who responded well and those who didn’t. Methylation plays a key role in regulating gene activity. “These differences were particularly pronounced in certain immune cells that are rarely found in the blood, but more common in the gut, where they perform important functions,” says Arnau-Soler. These included both specialized T cells, part of the adaptive immune system, and cells involved in the body’s innate defenses.

New biomarkers pave the way for personalized therapy

“Our results open the door to personalized approaches to treating peanut allergy – which affects three percent of all children in industrialized countries – more effectively and safely in the future,” says Lee. “We now have potential biomarkers to find out how well a child will respond to the therapy and what risks are associated with it in each individual case, even before the therapy begins.” It may soon be possible to tailor the length of treatment and the amount of peanut allergen given to each child’s unique immune profile.

The team is currently working to validate their findings in a follow-up study. They also plan to further investigate the gut-associated immune cells found in blood. “At the same time, we’re developing a predictive model so that in the future we can use a simple blood test to better tailor oral desensitization to the individual child,” adds Arnau-Soler. That could make peanut allergy far less frightening for families.

Source: Max Delbrück Center for Molecular Medicine

Categories : Diet and Nutrition PaediatricsTags :

Consuming Certain Sweeteners May Increase Risk of Early Puberty

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Photo by Amit Lahav on Unsplash

Consuming certain sweeteners commonly found in foods and beverages may increase the risk of early puberty in children, particularly among those who are genetically predisposed, according to a study being presented Sunday at ENDO 2025, the Endocrine Society’s annual meeting in San Francisco, Calif. 

The researchers found that consuming aspartame, sucralose, glycyrrhizin and added sugars was significantly associated with a higher risk of early puberty, especially in children with certain genetic traits. The more of these sweeteners the teens consumed, the higher their risk of central precocious puberty.

“This study is one of the first to connect modern dietary habits – specifically sweetener intake – with both genetic factors and early puberty development in a large, real-world cohort,” said Yang-Ching Chen, MD, PhD, of Taipei Municipal Wan Fang Hospital and Taipei Medical University in Taipei, Taiwan. “It also highlights gender differences in how sweeteners affect boys and girls, adding an important layer to our understanding of individualised health risks.” 

A type of early puberty known as central precocious puberty is increasingly common. It can lead to emotional distress, shorter adult height, and increased risk of future metabolic and reproductive disorders.

Chen’s previous research found that certain sweeteners can directly influence hormones and gut bacteria linked to early puberty. For example, one artificial sweetener, acesulfame potassium or AceK, was shown to trigger the release of puberty-related hormones by activating “sweet taste” pathways in brain cells and increasing stress-related molecules. Another sweetener, glycyrrhizin (found in liquorice) was found to change the balance of gut bacteria and reduce the activity of genes involved in triggering puberty. 

“This suggests that what children eat and drink, especially products with sweeteners, may have a surprising and powerful impact on their development,” Chen said.

The new findings come from the Taiwan Pubertal Longitudinal Study (TPLS), begun in 2018. The study included data from 1407 teens. Central precocious puberty was diagnosed in 481 teens. The researchers assessed teens’ sweetener intake through validated questionnaires and testing of urine samples. Genetic predisposition was quantified using polygenic risk scores derived from 19 genes related to central precocious puberty. Early puberty was diagnosed based on medical exams, hormone levels and scans. 

Sucralose consumption was linked to a higher risk of central precocious puberty in boys and consumption of glycyrrhizin, sucralose and added sugars was associated with a higher risk of central precocious puberty in girls.

“The findings are directly relevant to families, paediatricians and public health authorities,” Chen said. “They suggest that screening for genetic risk and moderating sweetener intake could help prevent early puberty and its long-term health consequences. This could lead to new dietary guidelines or risk assessment tools for children, supporting healthier development.”

Source: The Endocrine Society