Category: Paediatrics

Categories : PaediatricsTags :

Gymnast Simone Biles Urges Paediatricians to Report Abuse

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Renowned American gymnast Simone Biles has a combined total of more than 30 Olympic and world championship medals, not to mention several world records. But there’s more to her than that, she said during a plenary session at the American Academy of Pediatrics (AAP) virtual meeting.

“I’m a person at the end of the day and people respect that and understand that,” she said, noting that the positive support she received during the Japan summer games when she cited mental health concerns, and withdrew from several events, “made me feel whole as a person and an athlete.”

In her AAP keynote talk with AAP president Lee Savio Beers, MD, 24 year-old Biles explained that “Growing up, we’re told ‘Push through, Push through,’ but I knew at that point [during the 2020 Tokyo games, held in 2021], I really couldn’t…my safety and my health were on the line.”

She also acknowledged that “I honestly expected a lot more backlash than what I got [for withdrawing]. What I got was an overwhelming outpouring of support and love and understanding. That’s something I never expected…so that was quite a twist for me.”

Injury, overtraining, and pressure in competitive athletes can take a toll on athletes’ mental health, research has shown. Biles is among a number of high-profile athletes who have been outspoken about supporting the mental health of athletes. She has adopted a platform “to help advocate for mental health and support initiatives that provide education and assistance for children and young adults associated with adoption and foster care,” according to AAP News. Biles and her siblings were in and out of foster care before being adopted by their grandparents.

Biles also talked about Larry Nassar, DO, the former team doctor of the US women’s national gymnastics team who was jailed for sexual abuse and child pornography, and tampering with evidence.

In testimony before Congress in September, Biles said, “I blame Larry Nassar, and I also blame an entire system that enabled and perpetrated his abuse.” The gymnast singled out the FBI which she said “turned a blind eye” as Nassar molested young female patients, according to the Washington Post.

Biles offered this advice on how paediatricians can help abuse cases: “If you see something, speak up no matter what the consequences are because not only could you be helping that individual, but you could be helping multiple individuals too.”

Biles hopes more youth athletic programs will educate young children on spotting and reporting abuses. “From a very young age, a lot of us are thrown into these sports and we don’t know what’s right or wrong, unless somebody sits down and tells us, or we have adults looking after us, so I think handbooks can be a really good thing.”

Biles told the AAP audience that, before she became a gymnast, she wanted to be a paediatric nurse like her mother. “After making five World and two Olympic teams, the nursing career didn’t work out for me,” she said, “but…I’ve always wanted to help kids and I love kids…and I come from a family of [nurses].”

Source: MedPage Today

Categories : Allergies PaediatricsTags :

A Third of Children with Food Allergies are Bullied

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Using a multi-question assessment, researchers found that 1 in 3 children with food allergies reported food allergy-related bullying, indicating the problem is more widespread than commonly believed.

For the study, reported in the Journal of Pediatric Psychology, children were asked a simple ‘yes’ or ‘no’ question about food allergy-related bullying, to which 17% of kids indicated they’d been bullied, teased or harassed about their food allergy. But when asked to reply to a multi-item list of victimisation behaviours, that number jumped to 31%. Furthermore, Children’s National Hospital researchers found that only 12% of parents reported being aware of it. 

The reported bullying ranged from verbal teasing or criticism to more overt acts such as an allergen being waved in their face or intentionally put in their food. Researchers say identifying accurate assessment methods for this problem are critical so children can get the help they need.

“Food allergy-related bullying can have a negative impact on a child’s quality of life. By using a more comprehensive assessment, we found that children with food allergies were bullied more than originally reported and parents may be in the dark about it,” says Linda Herbert, Ph.D., director of the Psychosocial Clinical and Research Program in the Division of Allergy and Immunology at Children’s National and one of the study’s researcher.

“The results of this study demonstrate a need for greater food allergy education and awareness of food allergy-related bullying among communities and schools where food allergy-related bullying is most likely to occur,” Dr Herbert added.

The study examined food allergy-related bullying and evaluated parent-child disagreement and bullying assessment methods. It included 121 children and 121 primary caregivers who completed questionnaires. The children ranged in age from 9 to 15 years of age and had an allergy diagnosis of one or more of the top eight IgE-mediated food allergies: peanut, tree nut, cow’s milk, egg, wheat, soy, shellfish and fish.

Of the 41 youth who reported food allergy-related bullying:

  • 51% reported experiencing overt physical acts such as an allergen being waved in their face, thrown at them or intentionally put in their food.
  • 66% reported bullying experiences including non-physical overt victimisation acts including verbal teasing, remarks or criticisms about their allergy and verbal threats or intimidation.
  • Eight reported relational bullying, such as rumour spreading, people speaking behind their back and being intentionally ignored or excluded due to their food allergy.

The researchers also note that food allergy bullying perpetrators included, but were not limited to, classmates and other students, and bullying most commonly occurred at school.

The authors found that only 12% of parents reported that their child had been bullied because of their food allergy and of those, 93% said their child had reported the bullying to them. Some parents even reported being made fun of or teased themselves because of concerns about their child’s food allergy.

“It’s important to find ways for children to open up about food allergy-related bullying,” Dr Herbert said. “Asking additional specific questions about peer experiences during clinic appointments will hopefully get children and caregivers the help and support they need.

Source: Children’s National Hospital

Categories : PaediatricsTags :

Mothers’ Touch Synchronises Brainwaves and Heart With Babies

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A new study found that when mothers had close physical contact and played with their babies, their brain activity and heart rhythms synchronised.

Touch is fundamental to interpersonal communication, and was not until recently it was not known how affectionate touch and physical contact affect the brain activity and heart rhythms of mothers and babies. Developmental psychologists Trinh Nguyen and Stefanie Höhl from the University of Vienna have investigated this question in a study published in NeuroImage. 

Affectionate touch and bodily contact create social connections and can reduce stress. This effect has been observed in romantic couples, linked to a mutual alignment of brain activity and heart rhythms.  Since touch is a fundamental mode of communication between caregiver and infant, Trinh Nguyen, Stefanie Höhl and US colleagues sought to find out whether proximity and touch also contribute to the attunement of brain and heart rhythms between mother and baby.

In the new study, four to six-month-old babies played and watched videos together with their mothers. Functional near-infrared spectroscopy (fNIRS) was used to measure brain activity while electrocardiography (ECG) was used to simultaneously assess the heart rhythms of mother and baby. With fNIRS, changes in oxygen saturation are recorded in the outermost layer of the brain – here in particular in the frontal brain. Activation in this region is associated with mutual emotional attunement, attentiveness and self-regulation. These processes are particularly relevant for social interactions and develop during the first years.

The results showed that mother-baby pairs mutually adjusted their brain activity, especially when they touched each other. Mutual neural adjustment occurred when the mother held the baby close to her body and both watched a video together, and when they played together face-to-face and the mother lovingly touched the baby. The new study shows that touch plays a fundamental role in the early adaptation of brain activity between mothers and infants. An adaptation of heart rhythms was also shown when mother and baby played together, but it was independent of touch. In the case of the heartbeat, a mutual adaptation was particularly evident when babies signalled discomfort, which was presumably transmitted to the mothers.

The researchers next want to investigate how this mutual attunement in brain activity and heart rhythms affects long term development, particularly the later relationship between mother and child, as well as children’s language development.

Source: University of Vienna

Categories : Antibiotics PaediatricsTags :

Amoxicillin Flops in Simple Paediatric Chest Infections

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The largest randomised placebo-controlled trial of the antibiotic amoxicillin for treating paediatric chest infections has found it is little more effective at relieving symptoms than placebo. 

While viruses are believed to cause many chest infections in children, whether antibiotics are effective in treating chest infections in children is still debated. In adults, research has shown that antibiotics are not effective for uncomplicated chest infections.

In the study, published in The Lancet, researchers sought to test whether amoxicillin reduces the duration of moderately bad symptoms in children presenting with uncomplicated (non-pneumonic) lower respiratory tract chest infections in primary care. The trial recruited 432 children aged six months to 12 years-old with acute uncomplicated chest infections from primary care practices, randomised to receive either amoxicillin or a placebo three times a day for seven days. Doctors or nurse-prescribers assessed symptoms at the start of the study and parents, with help from their children where possible, completed a daily symptom diary.

Only a small, non-significant, difference in symptom duration was seen between the two groups: children given the placebo had symptoms which were rated moderately bad or worse for around 6 days on average after seeing the doctor, and those given antibiotics only recovered 13% faster.

This held true even for groups where chest sounds were present, there was a fever, was rated more unwell by a doctor, coughing up phlegm or had a rattly chest, or the child was short of breath.

Just four children in the placebo group and five in the antibiotic group required further assessment at hospital. Parental costs such as leave taken or over-the-counter remedies, were very similar in both groups.

The study lead author, Professor Paul Little, said: “”Children given amoxycillin for chest infections where the doctor does not think the child has pneumonia do not recover much more quickly.

“Indeed, using amoxicillin to treat chest infections in children not suspected of having pneumonia is not likely to help and could be harmful. Overuse of antibiotics, which is dominated by prescribing of antibiotics in primary care, particularly when they are ineffective, can lead to side effects and the development of antibiotic resistance.”

Study co-author Alastair Hay, a GP and University of Bristol professor, added: “The ARTIC PC trial is one of the very few studies to report on the effectiveness of prescribing antibiotics among younger children presenting with chest infections in primary care. It was designed to be able to detect a clinically important 3-day improvement in symptom duration.

“Our results suggest that unless pneumonia is suspected, clinicians should provide ‘safety-netting’ advice such as explaining what illness course to expect and when it would be necessary to re-attend but not prescribe antibiotics for most children presenting with chest infections.”

Source: University of Bristol

Categories : PaediatricsTags :

Managing Children Who Swallowed Button Batteries

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Small, flat ‘button’ batteries are commonly used in many electronic devices, and increasing numbers of children are ingesting button batteries, US data shows. A practice article in the CMAJ’s (Canadian Medical Association Journal) “Five things to Know About…” series highlights some key points for managing button battery ingestion.

  • Injuries from battery ingestion are increasing according to US data. Between 1999 and 2019, the United States National Poison Data System reported a 66.7% increase in yearly ingestion of button batteries and a 10-fold increase in complications.
  • Battery size and type influence complications. Lithium batteries and those 20 mm or larger are more dangerous and can become lodged in the oesophagus, especially in children under six years of age.
  • Urgency of management depends on the location of the battery. Batteries in the oesophagus should be removed immediately by a health care provider to prevent tissue erosion. Urgent removal in a health care setting is advised in children under five years who swallow batteries 20 mm or larger. Otherwise, children should be monitored as outpatients to see if they pass the battery.
  • Honey or sucralfate should be administered after battery ingestion. Honey given to children older than one year by their caregiver (10mL every 10 minutes, up to six doses) before arrival to the hospital and sucralfate administered in hospitals can reduce tissue damage due to swallowed button batteries.
  • Monitor children for long-term complications. Serious complications can occur despite removal of the battery. Caregivers should monitor for symptoms, including gastrointestinal bleeding and vomiting, weeks to months after removal.

Source: Medical Xpress

Categories : PaediatricsTags :

Better Outcomes in Children Receiving Living Donor Liver Transplants

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A new study from Children’s Hospital Los Angeles pooled examining outcomes for 8000 paediatric patients across four continents revealed that children receiving living donor liver tissue for transplants have a far lower risk of serious complications.

With medical advances and the liver’s fantastic regeneration capacity, healthy individuals can donate a portion of their liver. While many countries now exclusively perform living donor liver transplants, in the United States, only 8% of liver transplants are from living donors, such as those done by Children’s Hospital Los Angeles.

“We have published large-scale studies showing the benefits of living donor liver transplantation in adults,” said Juliet Emamaullee MD, PhD, Research Director, Division of Abdominal Organ Transplantation, Children’s Hospital Los Angeles. “And we’ve observed the benefits in kids too. But we really wanted to evaluate it systematically, to provide evidence from around the world to back up what we’ve seen.”
The screened over 2500 studies, distilling relevant studies, compiling data from 8000 paediatric patients who had received either living or deceased donor livers. Results showed that a year after the procedure, children who had received living donor liver transplants had nearly twice the survival rate while the risk of organ rejection was nearly halved.

Living donor tissue for liver transplants has a number of benefits, which may explain some of the difference in outcomes. Patients may need to wait a shorter time as they do not need to wait for an appropriately sized deceased organ donor, a particular challenge for infants and toddlers, who make up over 50% of paediatric liver transplants. But the biggest advantage may be that patients can be healthier at the time of their procedure.

“When a liver becomes available, the basic rule is that it goes to the sickest child,” said Dr Kohli. “And that makes sense. We don’t want any child dying on the waiting list.” Unfortunately though, this means that children can be on the waiting list for years before getting a transplant. They can be very ill as a result at the time of transplant, possibly affecting how well a child does once they receive a new liver.

“These results are important and relevant for families,” said Dr Emamaullee. “Not all children are at a center that offers living donor liver transplant. Now we have the data to suggest that kids really should be offered this option. Families should have the chance to donate to their children rather than having to wait until an organ donor comes along.”

“As a paediatrician, I want children getting the best chance possible,” said Dr Kohli. “Studies like these inform our care. They show us how to do the best possible job for our kids.”

Source: Children’s Hospital Los Angeles

Categories : PaediatricsTags :

Early Developmental Intervention Dramatically Cuts Autism Risk

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A first-of-its-kind study has shown that parent-led therapy supporting the social development of babies with early autism signs greatly reduced the odds of a later autism. 

The research, led by CliniKids at the Telethon Kids Institute and published in JAMA Pediatrics, found that a diagnosis of autism at age three was only a third as likely in children who received the pre-emptive therapy (iBASIS-VIPP)compared to those who received usual treatment.

The findings were the first evidence showing that a pre-emptive intervention during infancy could result in such a significant improvement in children’s social development that they then fell below the threshold for an autism diagnosis.

Study leader Professor Andrew Whitehouse, Telethon Kids Institute, said: “The use of iBASIS-VIPP resulted in three times fewer diagnoses of autism at age three. No trial of a pre-emptive infant intervention, applied prior to diagnosis, has to date shown such an effect to impact diagnostic outcomes – until now.”

Professor Whitehouse said many therapies for autism tried to replace developmental differences with more ‘typical’ behaviours. Instead, iBASIS-VIPP attempts to work with each child’s unique differences, creating a social environment around the child helping them learn in a way optimised for them.

“The therapy uses video-feedback to help parents understand and appreciate the unique abilities of their baby, and to use these strengths as a foundation for future development,” said Professor Whitehouse. “By doing so, this therapy was able to support their later social engagement and other autistic-related behaviors such as sensory behaviors and repetitiveness, to the point that they were less likely meet the ‘deficit-focused’ diagnostic criteria for autism.”

“We also found increased parental sensitivity to their baby’s unique communication and an increase in parent-reported language development. Other general aspects of development were not affected.” The children falling below the diagnostic threshold still had developmental difficulties, but by working with each child’s unique differences, rather than trying to counter them, the therapy has effectively supported their development through the early childhood years.”

The four-year randomised clinical trial enrolled babies aged 9-14 months, all of whom having shown early behavioural signs of autism. Over five months, half received the video intervention, while a control group received current best practice treatment.

Eighty-nine children completed an assessment at the start of the study, at the end of the therapy period, and when they were two and three years of age. With the high prevalence of autism worldwide, the implications of the findings were enormous, said Professor Whitehouse. Around 2% of all children in Australia have an autism diagnosis.
“Autism is not typically diagnosed until three years of age, however, interventions commencing during the first two years of life, when the first signs of development difference are observed and the brain is rapidly developing, may lead to even greater impact on developmental outcomes in later childhood,” Professor Whitehouse said.

Professor Whitehouse said that a follow-up of study participants in later childhood, when autism behaviours may be more apparent, would be critical to determining the longer-term significance of the video intervention.

Source: Telethon Kids Institute

Categories : Paediatrics Respiratory DiseasesTags :

Surprising Finding Links Asthma Risk to Meat Consumption as Infants

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Researchers looking for post-breastfeeding dietary patterns in two prospective birth cohorts, were surprised to discover meat consumption as a predictive factor.

Alexander Hose, MA, MPH, of Ludwig Maximilian University in Munich presented the study’s findings at the virtual European Respiratory Society annual meeting. 

After switching from breast milk, babies up to age 1 whose protein intake came largely from meat products, rather than dairy, fish, or egg proteins, had a more than eight-fold greater chance of developing asthma by age 6 versus non-meat protein consumption. Asthma prevalence reached 30% in some subgroups.

Wheezing was more common in this diet pattern, which Hose and colleagues termed “unbalanced meat consumption” (UMC); this continued up to age 10, with a five times higher odds.

The duration of breastfeeding was an important factor, likely because switching to baby foods prolonged the exposure. Odds of developing asthma by age 6 increased nearly 12-fold in UMC-fed infants whose breastfeeding stopped by week 19, versus about four-fold in those continuing longer on breast milk.

In addition, UMC was also linked to a certain intestinal microbiome profile featuring unusually high levels of Lactococcus, Granulicatella, and Acinetobacter species.

This type of microbiome scavenges iron in the gut, Hose said, which could explain why the children became especially susceptible to asthma. Additionally, milk proteins may exert an opposite effect on asthma risk by generating a type of “nutritional immunity.”

While the mechanism connecting the gut microbiome to respiratory disease is unknown, the existence of a ‘gut-lung axis‘ is well established; a recent trial showed that probiotics can prevent coughs and wheezing in older adults. The phenomenon has also been considered for COVID’s gastrointestinal symptoms.

A pair of European birth cohort studies, PASTURE and LUKAS2, provided the data for the study. In these, about 1400 infants were followed through age 10 and parents kept detailed records of their infants’ feeding, and other environmental factors, and children’s medical records were accessed as well.

However, a key limitation is the cohorts being from rural areas since investigating asthma’s relationship to animal exposure was a key goal for the studies. Partly because of this, Hose and colleagues were able to separate out ‘industrial’ meat, milk, and yoghurt from that produced at home. A trend toward greater asthma risk was observed with store-bought protein products.

Source: MedPage Today

Categories : Gender PaediatricsTags :

Study Highlights Role of Sex Hormones in Behavioural Development

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A new study shows that sex hormones are important for developing gender role behaviours in boys, such as active play.

In laboratory animals, sex differences in behaviour arise from different hormone levels produced by males and females influence patterns of gene expression in the developing brain. However, the origins of sex differences in human behaviour are not as well understood.

“In the lab, you can do experiments on how these hormones affect animal brains and perform other experimental manipulations. We can’t do those things to people, so we looked to a natural experiment,” explained study leader David Puts, associate professor of anthropology.

Prof Puts and his collaborators made use of a natural experiment called isolated GnRH deficiency (IGD), a rare endocrine disorder. Individuals with IGD lack sex hormones from the second trimester of development right through until they begin hormone replacement therapy to induce puberty. However, as the external genitals develop earlier, during the first trimester, people with IGD are clearly male or female at birth, and are raised according to their sex. 

IGD therefore presents the chance to study the behaviour of those raised as boys but exposed to low testicular hormones, or raised as girls but exposed to low ovarian hormones.

The researchers compared 97 individuals with IGD (a small number due to its rarity) to 1665 individuals with typical hormonal development. Differences in behaviour were investigated; boys being encouraged toward active play, girls pushed to more passive pursuits. The researchers asked subjects to recall behaviours they had as children.

“We asked them, ‘When you read a book, were you the male or female in the story?’, ‘Where your friends boys or girls?’, ‘Did you play with dolls or trucks?’,” said Talia N Shirazi, doctoral recipient in anthropology now working in the reproductive health industry.

These childhood gender role behaviours are among the largest differences in behaviour between sexes, Prof Puts said. Typically, males will say they were the male character, played with other boys and preferred trucks, while females will say they were the female character, played with other girls and preferred dolls.

However, males with IGD reported more gender non-conforming in this regard. The researchers found in that men with IGD recalled a higher level of childhood gender non-conformity than typical men, while women with IGD did not differ from typical women in childhood gender conformity.

‘”We don’t see this effect in the women with IGD,” said Shirazi, indicating that low levels of ovarian hormones does not significantly impact childhood gender role behaviours.

“Our results suggest that in humans, androgens, such as testosterone produced by the testes, influence male brain development directly as they do in other mammals, rather than only indirectly by influencing external appearance and consequently gender socialisation,” said Prof Puts. “Both the direct influence of androgens on the developing brain and gender socialisation probably play important roles in producing sex differences in childhood behaviour.”

Prof Puts and Shirazi agree that despite their modest sample of participants with IGD, they are encouraged that the results were very similar in subjects who came from a clinical setting and those recruited from support groups.

“It would be nice to be able to identify people with IGD when they are younger, before they reach what should be puberty,” said Shirazi. “We need to focus on recruitment for our studies because there is a lot that can be learned about the cause of gender behaviours.”

Source: Penn State

Categories : PaediatricsTags :

Glasses Boosts Academic Performance for Students Who Need Them

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Students receiving eyeglasses through a school-based initiative scored higher on reading and math tests, found in the largest clinical study of the impact of glasses on education ever conducted in the US. Students struggling the most academically showed the greatest improvement.

The study by Johns Hopkins researchers from the Wilmer Eye Institute and School of Education is published in JAMA Ophthalmology.

“We rigorously demonstrated that giving kids the glasses they need helps them succeed in school,” said senior author Megan Collins, a paediatric ophthalmologist at the Wilmer Eye Institute. “This collaborative project with Johns Hopkins, Baltimore City and its partners has major implications for advancing health and educational equity all across the country.”

The team studied students who received eye examinations and glasses through the Vision for Baltimore program. The effort was launched in 2016 after an acute need for vision care among the city’s public school students was identified: as many as 15 000 of the city’s 60 000 pre-K (age 2 to 4) through 8th-grade (age 13 to 14) students likely needed glasses though many were unaware or were unable to get them.

Over five years, Vision for Baltimore has tested the vision of more than 64 000 students and distributed more than 8000 pairs of glasses. The Johns Hopkins study represents the most robust work thus far evaluating whether having glasses affects a child’s performance in school.

The three-year randomised clinical trial, conducted from 2016 to 2019, analysed the performance of 2304 students in grades 3 to 7 who received screenings, eye examinations and eyeglasses from Vision for Baltimore. The team looked at their scores on standardised reading and math tests, measuring both 1-year and 2-year impact.

After one year, reading scores increased significantly for students who got glasses, compared to those getting glasses later. There was also significant improvement in maths for students in primary grades.

There were particularly striking improvements for girls, special education students, and students who had been among the lowest performing.

Megan Collins, senior author said, “The glasses offered the biggest benefit to the very kids who needed it the most – the ones who were really struggling in school.”

The gains were about the same as two to four months of extra education compared to students with glasses, said lead author Amanda J Neitzel, deputy director of evidence research at the Johns Hopkins Center for Research and Reform in Education. For students performing in the lowest quartile and students in special education, wearing glasses equated to four to six months of additional learning.

“This is how you close gaps,” Neitzel said.

However, the academic improvements seen after one year were not sustained over two years. Researchers suspect this could be a result of students starting to wear their glasses less, perhaps from loss or breakage.

To keep up the academic achievement boost, the researchers recommend that school-based vision initiatives should also try to ensure children are wearing the glasses and to replace them if needed.

Source: Johns Hopkins University