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Your Baby

High-Sugar Intake During Mom’s Pregnancy May Double Child’s Risk of Asthma

2:00

It’s no secret that moms-to-be often develop a sweet tooth during pregnancy, but new information suggests high-sugar foods and drinks may double their child’s risk for developing asthma and allergies later in life.

Researchers from Queen Mary University of London used data gathered from nearly 9,000 mother-child pairs in the Avon Longitudinal Study of Parents and Children, an ongoing research project that tracks the health of families with children born between April 1, 1991, and December 31, 1992.

During the study, the participating pregnant women were asked about their weekly intake of certain foods and specific food items including sugar, coffee and tea. Their responses were used to calculate their intake of added sugar.

The researchers only saw weak evidence to suggest a link between women’s added sugar intake and their children’s chances of developing asthma overall. But when they looked specifically at allergic asthma—in which an asthma diagnosis is accompanied by a positive skin test for allergens—the link was much stronger. Children whose moms were in the top fifth for added sugar during pregnancy were twice as likely to have allergic asthma when compared to children whose moms were in the bottom fifth.

Children of mothers with the high-sugar diets were 38% more likely to test positive for an allergen and 73% more likely to test positive for more than one allergen, compared to those kids whose moms stayed away from added sugar.

"The dramatic 'epidemic' of asthma and allergies in the West in the last 50 years is still largely unexplained -- one potential culprit is a change in diet," said Annabelle Bedard, lead author and a postdoctoral fellow at Queen Mary's Centre for Primary Care and Public Health Blizard Institute. "Intake of free sugar and high fructose corn syrup has increased substantially over this period."

As with most studies, a cause and effect was not established, only an association. The study’s authors believe that the association is strong enough to warrant further investigation.

Lead researcher Professor Seif Shaheen  said: "We cannot say on the basis of these observations that a high intake of sugar by mothers in pregnancy is definitely causing allergy and allergic asthma in their offspring.

"However, given the extremely high consumption of sugar in the West, we will certainly be investigating this hypothesis further with some urgency.”

There are many health reasons why pregnant women should limit their intake of high-calorie and sugary foods and drinks. This research suggests that it may be prudent for the health of their unborn child as well.

Story sources: Susan Scutti, http://edition.cnn.com/2017/07/05/health/sugar-pregnancy-child-allergy-asthma-study/index.html

 Henry Bodkin, http://www.telegraph.co.uk/science/2017/07/06/high-sugar-intake-pregnancy-linked-double-risk-child-asthma/

Daily Dose

Asthmatic Kids & Colds

2.00 to read

Cold season continues to hang on and for anyone who has a child with asthma, you are aware that wheezing will often accompany winter colds.

I have spent a lot of time in the last week listening to wheezy chest, lots of coughing and seeing many children who need to be using their asthma medications. After a quiet summer of no coughing it is a good time to review asthma and the medications to use to treat as “wheezy season” is here!

Many children will wheeze once in their lifetime and I tell parents, “everyone gets one free wheezing episode”. But if a child wheezes on several occasions and responds to bronchodilators they probably have asthma. If you throw in a positive family history of wheezing as well as wheezing that begins each time a child gets a cold it is time to discuss the diagnosis of asthma and the treatments that go along with the diagnosis.

The good news about asthma is that there are a lot of great medications available for treatment. With that being said I think it is important to teach parents about the pathophysiology of asthma and then talk about treatment. I tell my patients/parents that understanding wheezing is somewhat analogous to being a medical intern. You have to see the symptoms for a while and then you finally “learn it, and know it” and then can begin to understand treatment.

For a parent with a child with asthma it is the same process. Each repeated wheezing episode should get easier for a parent to know what they are dealing with and when and how to start treatment. Many times they will not need the doctor to be involved once they are comfortable with the medications.

In fairly simplistic terms, there are really two components to asthma, airway narrowing (brochospasm) and airway inflammation. In most cases it is important to be treating both symptoms. The most common trigger for asthma in children is a viral upper respiratory infection. When you get a viral upper respiratory infection the virus causes airway inflammation and irritation in all of us. That is one reason we all cough with a cold.

For an asthmatic child it also causes bronchospasm and resultant wheezing. By the time you audibly hear your child wheezing they are what we pediatricians refer to as “being tight”. The goal is therefore to treat the asthmatic episode early and aggressively; you never want to hear audible wheezing.

An asthmatic cough is often short, frequent, non productive and occurs throughout the day and often all night long. I love to walk into a room and hear a child with a productive, “phlegmy” cough, as these children are typically not wheezers but are good coughers! It is that dry little recurrent pesky cough that occurs incessantly that is often the hallmark of a child who is wheezing.

In severe cases of wheezing and bronchospasm the child will also show signs of respiratory distress, where their chest may show retractions (pulling in between ribs) or using their abdominal muscles to help them breath. These children look uncomfortable and are usually not running around the exam room as they are having a hard time getting air exchanged.

Some other children may not be in any respiratory distress but when listened to with the stethoscope you can hear the high pitched noise on expiration and sometimes on inspiration as well. You just have to get used to listening. Practice, practice and then a parent with a stethoscope gets better at understanding asthma.

When a child is actively wheezing it is time to start medications to relieve their symptoms. More on treatment coming.  Stay tuned.

Daily Dose

Asthma

1:30 to read

May is Asthma Awareness Month and I am certainly seeing many patients whose asthma and wheezing is getting the best of them right now. With all of the major weather changes across the country, pollen counts through the roof, and upper respiratory viruses still circulating, there are quite a few triggers to set off wheezing.

 

Asthma is a chronic lung disease and affects more than 6 million children in the United States. Asthma causes wheezing and chest tightness in some, while it may only cause nighttime cough and cough with exercise in others. There is not one single presentation to asthma and the diagnosis is best made with a good history and physical exam.  Although asthma is a chronic disease you may only have attacks when something is bothering your lungs (triggers).

 

The biggest challenge I see as a pediatrician is teaching both parents and children to recognize their triggers and to know what their medications are. Every patient should have an asthma action plan, but in some cases, a child may have only wheezed once..and their parents received an inhaler or a nebulizer but really does not know what to do if their child wheezes again.

 

If your child has wheezed before, and you have a family history of wheezing, your child has a greater chance of wheezing again.  You should have a discussion with your pediatrician about how to recognize wheezing in your child. At the same time, if you have ever received a medication for wheezing, make sure you know the name or names of the medication. I see many parents who come in to the office and they may have been seen at an ER or urgent care when they were noted to be wheezing. They received an “inhaler”, but the parent has no clue as to the name of the inhaler (they may say, “it is blue”), and they don’t understand how the medications work.

 

The two points I try to make with every patient I see with wheezing:  

#1  Know the names of the medications that you have

#2  Know what the medications do

 

There are two issues with asthma, lung inflammation and broncho spasm (narrowing of the airways). So…there are two medications commonly used to treat these issues.  Inhaled steroids (there are tons of brands) are used as a preventative and decrease inflammation, while albuterol (again tons of brands) is a broncho-dilator and opens up the narrowed airways.  I see too many patients that bring in a bag full of medications, from numerous doctors and still don’t understand what their medications are used for, when to use them and that several of their inhalers, while having different names, are actually the same medicine.

 

Lastly, children with divorced parents need to have inhalers available at both homes. I think it is too complicated to try and have parents hand the inhaler or medication back and forth and think they will not forget or lose the medication.  Ask your doctor to have meds for both houses.

Seeing that is is Asthma Awareness month, get your medications out and make sure that they are not expired and if you don’t understand how or when to use them, make an appointment with your pediatrician and get an asthma action plan in place. Be prepared!  

Your Child

Low Pollen Levels Can Trigger Asthma

2.00 to read

Asthma in children has been on the increase since the 80s and the current estimated number of American children with asthma is between 6 and 9 million. It is the leading cause of chronic illness in kids under 18 years old. If your child is sensitive to pollen, a new study suggests that even low levels can increase the chances of an asthma attack. . 

Yale and Brown University researchers tracked more than 400 children with asthma, as well as the daily pollen levels near each child's home, over the course of five years. Researchers found that there was a 37% increase in respiratory symptoms in children who were sensitive to pollen- even though pollen levels were very low- and they were taking daily medications to control their asthma.

“In some respects, it's common sense that if a child is asthmatic and allergic to pollen, when they're exposed to pollen, they would bear some risk of asthmatic symptoms," said lead author Curt DellaValle, of the Yale School of Forestry and Environmental Studies.

"The biggest thing, though, is seeing these effects even with the lowest levels of pollen," he told Reuters Health. "It leads us to believe that parents of these asthmatic children should be aware that even when pollen levels are low, their children will experience asthmatic symptoms."

The study also revealed data that surprised researchers. Pollen-sensitive kids that were part of the study had fewer symptoms when ragweed – a major irritant- was at high levels. DellaValle said it may mean that the children's parents reacted to high pollen reports and took extra precautions.

"It suggested that they modified their children's behavior by keeping them inside, in air conditioning or by using air filters," DellaValle said.

Here’s how the study worked:

DellaValle's team recruited 430 children with asthma between the ages of four and 12 in New York, Connecticut and Massachusetts between 2000 and 2003. Each kid's mother kept a calendar tracking her child's asthma symptoms and use of asthma medications. The researchers also tested the children's blood for sensitivity to pollens from trees, grass and weeds.

To get a better picture of realistic pollen exposures, every year during the Northeast's pollen season -- generally from late March to early October -- the researchers used a model to analyze the amount of pollen within 1.2 miles of each child's home. They also tracked daily and seasonal weather, foliage, when pollen seasons began and ended and peak pollen periods.

Among kids with sensitivities to particular types of pollen, even small amounts in the air could trigger asthma symptoms.

Children not on maintenance medication who were sensitive to grass pollen, for example, wheezed, coughed and had trouble breathing and other nighttime symptoms when they were exposed to more than two grains per cubic meter of grass pollen.

Kids on daily maintenance therapy and sensitive to weed pollen could have similar symptoms and a need for rescue medication at pollen levels above six to nine grains per cubic meter.

Among the kids sensitive to weed pollen, low-level exposures raised their risk of symptoms by 37 percent. That compared to a 23 percent rise in risk during the highest weed-pollen periods -- hinting that kids may have stayed indoors when pollen levels were known to be high, the researchers note.

Pollen levels were not tied to an increase in asthma symptoms in kids without allergies to specific pollens.

Parents with asthmatic children often follow pollen reports and adjust their children’s outdoor activity accordingly. This study shows that even low levels of pollen can affect a sensitive child’s breathing and general health.

Although there is no cure for asthma, it can be managed with proper prevention and treatment. There is often a genetic compound.

Asthma symptoms can be mild or severe, and many children’s symptoms become worse at night.

Symptoms may include:

- Frequent, intermittent coughing.

- A whistling or wheezing sound when exhaling.

- Shortness of breath.

- Chest congestion or tightness.

- Chest pain, particularly in younger children.

- Trouble sleeping caused by shortness of breath, coughing or wheezing.

- Bouts of coughing or wheezing that get worse with a respiratory infection, such as a cold or the flu.

- Delayed recovery or bronchitis after a respiratory infection.

- Trouble breathing that may limit play or exercise.

- Fatigue, which can be caused by poor sleep.

If your child experiences any of the above symptoms, make sure he or she is seen by a pediatrician or family doctor. 

 

 

Sources:

http://www.reuters.com/article/2011/12/01/us-pollen-levels-idUSTRE7B02HG...

http://www.mayoclinic.com

Your Child

The Eczema, Allergies and Asthma March

1:45

Eczema refers to a number of different skin conditions in which the skin becomes red and irritated and sometimes has small, fluid filled bumps that ooze.

The most common cause of eczema is atopic dermatitis (sometimes called infantile eczema), which affects older kids as well as infants.

Children with eczema may eventually get food allergies, hay fever, or asthma. But you can take steps to soothe the itch and possibly cut the risk of allergies.

While most experts don't think eczema is purely allergic, it's clearly connected to allergic conditions like food allergies, hay fever, and asthma.

·      Up to 80% of kids with eczema get hay fever or asthma later in childhood.

·       35% of adults with asthma or nasal allergies had eczema as kids.

·      If a mom has allergies, there's almost a 1 in 3 chance that her baby will have eczema.

·      37% of kids with moderate to severe eczema also have food allergies.

For some kids, eczema and allergies develop in a specific order, as they get older. It starts with eczema, then food allergies, then asthma, and then hay fever. It's called the allergic march.

But just because your child has eczema doesn't mean they'll get these other conditions. It just means there's a higher risk.

There are several things that can increase a child’s risk of being part of the allergic march.  Kids who get eczema at a young age may be more likely to have allergies or asthma later. Kids with worse eczema symptoms may be more likely to get allergies or asthma.

You can do some things that might lower your child's chances of worsening eczema, asthma, or allergies. The evidence isn't clear, so talk to your doctor or your child's pediatrician. Depending on the situation, the doctor might recommend:

Breastfeeding your baby: It might lower the risk of eczema, later allergies, or asthma.

Diet changes: If your baby has a high risk of allergic problems, some doctors recommend changes in diet. Breastfeeding for at least 4 months can help protect your child. “Hydrolyzed” formula might help protect formula-fed babies.

Other ways to keep your child's eczema under control include:

Get allergy testing. If you can pin the problem on a specific allergen, you can figure out ways to avoid it.

Use a moisturizer. Go for thick creams and ointments that stop the skin from drying out.

Keep fingernails short. Your child will do less damage to the skin from scratching.

Avoid irritants. Always use unscented soap and laundry detergent. Stay away from cigarette smoke.

Watch for problems. If your child's eczema seems to be getting worse -- or if they get allergy symptoms, like congestion or a runny nose -- see a doctor. The sooner you get treatment, the sooner your child will feel better.

In many cases, eczema goes into remission and symptoms may disappear altogether for months or even years.

For many kids, it begins to improve by the age of 5 or 6; others may have flare-ups throughout adolescence and early adulthood.

In some kids, the condition may improve but then restart as they enter puberty, when hormones, stress, and irritating skin products or cosmetics are introduced. Some people will have some degree of dermatitis into adulthood, with areas of itching and a dry, scaly appearance.

Eczema is not contagious, so there's no need to keep a baby or child who has it away from siblings, other kids, or anyone else.

Story sources; http://www.webmd.com/skin-problems-and-treatments/eczema/child-eczema-14/allergies?ecd=wnl_prg_050116&ctr=wnl-prg-050116_nsl-promo-4_title&mb=HJinmVxrQQBBWXaWABbkR%40HnVev1imbCiW2HnNaB9FE%3d

http://kidshealth.org/en/parents/eczema-atopic-dermatitis.html#

 

 

 

Your Child

New Studies Look At Childhood Asthma

1.45 to read

2 new studies take a look at childhood asthma. One suggests that antibiotics given to babies in the first year of life may increase a child’s chances of getting asthma by age 18, while the other study cautions that childhood food allergies may be a predictor of asthma later in life.2 new studies take a look at childhood asthma. One suggests that antibiotics given to babies in the first year of life may increase a child’s chances of getting asthma by age 18, while the other study cautions that childhood food allergies may be a predictor of asthma later in life

Antibiotic Use and Childhood Asthma Pediatricians have cautioned parents about taking antibiotics, and giving their children antibiotics, without a true medical need. Now a study appearing online in the journal Pediatrics, suggests that infants who take antibiotics during the first year of life may be at a slightly increased risk of developing asthma by age 18. In a separate analysis, the children of women who took antibiotics during pregnancy were nearly 25% more likely to have asthma compared to mothers who did not take the drug. Asthma can be a life threatening condition. Nine million children under age 18 in the U.S. have asthma, according to the American Academy of Allergy, Asthma & Immunology. Here’s how the study was conducted. Researchers gathered data from 22 previous studies between 1950 and 2010. Two of the 22 studies looked at antibiotic exposure during pregnancy while 19 studies evaluated antibiotic exposure during the first year of life. One study assessed antibiotic exposure during both time periods. Other studies have shown that infants who receive antibiotics are at an increased risk for developing asthma by age 7, and the more courses of the drug given that first year, the greater the risk. This review analyzed the results of studies using over 600,000 participants. It also grouped studies according to design type to see how the results were affected. When all 20 studies were grouped together, researchers found that infants who took antibiotics during their first year of life were about 50% more likely than babies who never received the drugs to be diagnosed with asthma. Researchers also analyzed studies where children who were treated with antibiotics for respiratory infections, were removed.  The respiratory infections skewed the overall results because of the possibility that the infections themselves might be a precursor to asthma. In studies that adjusted for these respiratory infections, a child who took antibiotics was 13% more likely to be diagnosed with asthma than a child who never took the medication. The researchers say they are not suggesting that early antibiotic exposure causes childhood asthma, but that even a slight increase in risk may be a good enough reason to avoid the unnecessary use of antibiotics during pregnancy and the first year of life. Food Allergies and Childhood Asthma Infants and toddlers often have some type of food allergy, while teens and adults are more prone to dust, ragweed and mold allergies according to U.S. researchers. A preliminary release of the Quest Diagnostics Health Trends Report, Allergies Across America, is based on laboratory testing from more than 2 million U.S. patient visits. In this report the findings reveal a pattern of allergen sensitivity consistent with the "allergy march," a medical condition by which allergies to foods in early childhood heighten the risk for the development of additional and more severe allergy-related conditions - including asthma- later in life. "Allergy and asthma often go hand in hand, and the development of asthma is often linked to allergies in childhood via the allergy march," Study investigator Dr. Harvey W. Kaufman says in a statement. "Given the growing incidence of asthma in the United States, our study underscores the need for clinicians to evaluate and treat patients, particularly young children, suspected of having food allergies in order to minimize the prospect that more severe allergic conditions and asthma will develop with age." The most common foods responsible for allergic reactions are eggs, cow's milk, peanuts, soya, fish and shellfish in children and peanuts, tree nuts, shellfish and fish in adults. Substances that are used as food additives and preservatives can also affect individuals. Although a causal link has not been determined, increased awareness of the heightened risks of having both childhood asthma and allergen sensitivity plus good patient-parent education and management of both conditions, can lead to improved health and medical outcomes.

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Asthma

Managing Your Child's Asthma

Your Teen

Acetaminophen, No Threat To Child's Liver

2.00 to read

With more than eight million American kids taking the drug every week, acetaminophen is the nation's most popular drug in children. It's toxic to the liver in high doses, and can be fatal if taken in excess. Very rarely, adults may also get liver damage at normal doses, so doctors had worried if the same was true for kids. Concerns about liver injuries in children who take the common painkiller acetaminophen, sold as Tylenol in the U.S. are unfounded, researchers said on Monday. "None of the 32,000 children in this study were reported to have symptoms of obvious liver disease," said Dr. Eric Lavonas of the Rocky Mountain Poison and Drug Center in Denver. "The only hint of harm we found was some lab abnormalities." With more than eight million American kids taking the drug every week, acetaminophen is the nation's most popular drug in children. It's toxic to the liver in high doses, and can be fatal if taken in excess. Very rarely, adults may also get liver damage at normal doses, so doctors had worried if the same was true for kids. "This drug is used so commonly that even a very rare safety concern is a big concern," said Lavonas, whose findings appear in the journal Pediatrics. Some researchers suspect there is a link between long-term use of acetaminophen and the global rise in asthma and allergies, but the evidence is far from clear at this point. For the new report, researchers pooled earlier studies that followed kids who had been given acetaminophen for at least 24 hours. There were no reports of liver injuries leading to symptoms such as stomachache, nausea or vomiting, in the 62 reports they found. Ten kids, or about three in 10,000, had high levels of liver enzymes in their blood, which usually means their livers have been damaged. In most cases, however, those elevations were unrelated to acetaminophen. And even if they were caused by the drug, they don't indicate lasting damage, according to Lavonas. "Acetaminophen is extremely safe for children when given correctly," he said. "Parents should not be afraid to give acetaminophen to their children when they need it, but they should be very careful about giving the right dose." "If you suspect that you have given a child an overdose, call your state's poison center," he added. The Rocky Mountain Poison and Drug Center receives funding from McNeil Consumer Healthcare, the Johnson & Johnson subsidiary that sells Tylenol, but the researchers said the company did not support this study.

Your Child

Kid’s Asthma: Test For Pollutants Inside the Home

1:45

If your child suffers from asthma, he or she should be tested to see if they are allergic to indoor pollutants such as dust mites, insects, pet dander, molds, secondhand cigarette smoke and certain household cleaning supplies says a new clinical report released by the American Academy of Pediatrics (AAP).

Controlling the triggers of asthma in the home may work as well as or reduce the need for medications wrote Elizabeth C. Matsui, MD, MHS, FAAP,  of Johns Hopkins Hospital in Baltimore and colleagues, authors of the new guidance in the November issue of Pediatrics.

"We know that targeting all exposures that can trigger a child's asthma is more likely to be successful and to result in significant improvement than targeting only one or two of them, and can help reduce asthma attacks and the need for medication," Matsui said.

According to the report, an assessment of a child's individual environmental history should be an integral part of asthma management. The authors urged pediatricians to ask families about exposure to the following common triggers:

·      Dust mites and mold: An estimated 30-62% of children with persistent asthma are allergic to dust mites, and about half are sensitive and exposed to mold.

·      Furry pets: Cats and dogs are common furry pets found in homes, yet up to 65% of children with persistent asthma report being allergic.

·      Presence or evidence of pests such as cockroaches and rodents: Cockroach allergen exposure was first linked to asthma morbidity in children in 1997, and the link has been replicated ever since. Nearly 75-80% of U.S. homes contain detectable amounts of mouse allergen. Concentrations in homes in neighborhoods with high poverty rates are up to 1,000-fold higher than those found in suburban homes.

·      Indoor air pollution: Cigarette smoke is a major indoor trigger, with nearly 30% of all U.S. children and 40-60% of U.S. children in low-income households exposed to second-hand smoke in their homes. Additionally, the use of older wood-burning stoves, unvented space heaters, and other sources of combustion can produce nitrogen dioxide and other pollutants that are known to exacerbate asthma symptoms.

·      Household chemicals: Common household items such as air fresheners and cleaning agents include chemicals that can be respiratory irritants and trigger asthma symptoms.

The report recommended seeing an allergist to identify which allergens may be triggering your child’s asthma.

By asking specific questions, Matsui noted that pediatricians can play an important role in helping parents recognize something in the house may be making their child’s asthma worse.

"Which exposures to focus on will be informed by questions the pediatrician asks of the family," Matsui said. "Asking about pets will identify children who may have pet allergen exposure contributing to their asthma. Similarly, asking about signs of mouse or cockroach infestation will indicate which children might be at risk from these exposures."

Additionally, pediatricians should routinely ask about second-hand smoke exposure as this will guide further discussion about ways to eliminate or reduce a child's exposure to smoke, she said.

Dust mites are the most common indoor pollutant, however, you won’t see these pests crawling around your house. They are so tiny - a microscope is needed to actually see them. They feed mainly on the tiny flakes of human skin that people shed each day. These flakes work their way deep into the inner layers of furniture, carpets, bedding and even stuffed toys. These are the places where mites thrive. An average adult person may shed up to 1.5 grams of skin in a day. This is enough to feed one million dust mites!

Having dust mites doesn’t mean your house isn’t clean. Even the cleanest of houses can harbor these unwelcomed creatures. You can find out more about dust mites at http://www.aafa.org/page/dust-mite-allergy.aspx.

Indoor allergens can definitely make your child’s asthma worse and although many insurers do not currently cover environmental assessments and control measures, there are both public and private resources available to aid pediatricians, specialists, and patients with environmental remediation efforts.

Story source: Alexandria Bachert, http://www.medpagetoday.com/pediatrics/asthma/61125

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