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Your Baby

Obese During Pregnancy Linked to Obesity in Offspring

2:00

Not every time, but often, you’ll see obese couples and their kids are either obese or on the threshold of obesity. While adults have the power and the life experience to understand the health issues associated with obesity, their children – depending on their age- are reliant on on their parents making healthy choices for them.  

 Is generational obesity inherited or a case of families making poor choices where food and exercise are concerned – or both?

Researchers from the University of Colorado School of Medicine wondered if children born to obese moms might be predisposed to being obese due to their womb environment.

The team of scientists analyzed stem cells taken from the umbilical cords of babies born to normal weight and obese mothers. In the lab, they coaxed these stem cells to develop into muscle and fat. The resulting cells from obese mothers had 30% more fat than those from normal weight mothers, suggesting that these babies’ cells were more likely to accumulate fat.

No cause and effect was established, but the scientists noted that further research was needed. “The next step is to follow these offspring to see if there is a lasting change into adulthood,” says the lead presenter, Kristen Boyle, in a statement.

She and her colleagues are already studying the cells to see whether they use and store energy any differently from those obtained from normal-weight mothers, and whether those changes result in metabolic differences such as inflammation or insulin resistance, which can precede heart disease and diabetes.

Other studies have found a high correlation between parents’ Body Mass Index (BMI) numbers and their children ‘s BMI, particularly between mothers and their kids. Further, the BMI of grandmother’s and their grandchildren is also high.

What is a healthy weight gain for a pregnant woman? It depends on how much you weigh before getting pregnant.

The guidelines for pregnancy weight gain are issued by the Institute of Medicine (IOM); most recently in May 2009. Here are the most current recommendations:

•       If your pre-pregnancy weight was in the healthy range for your height (a BMI of 18.5 to 24.9), you should gain between 25 and 35 pounds, gaining 1 to 5 pounds in the first trimester and about 1 pound per week for the rest of your pregnancy for the optimal growth of your baby.

•       If you were underweight or your height at conception (a BMI below 18.5), you should gain 28 to 40 pounds.

•       If you were overweight for your height (a BMI of 25 to 29.9), you should gain 15 to 25 pounds. If you were obese (a BMI of 30 or higher), you should gain between 11 and 20 pounds.

•       If you're having twins, you should gain 37 to 54 pounds if you started at a healthy weight, 31 to 50 pounds if you were overweight, and 25 to 42 pounds if you were obese.

These recent findings point out again, how important it is for pregnant women to consider the possible long - term health affects on their unborn offspring when making decisions about their own health.

The report was presented in May to the American Diabetes Association.

Sources: Alice Park, http://time.com/3906135/obese-moms-wire-kids-obesity-during-pregnancy/

http://www.babycenter.com/0_pregnancy-weight-gain-what-to-expect_1466.bc

 

Your Baby

Kids of Obese Mothers at Higher Risk for Autism, ADHD

1:45

A new study points out another reason that obesity and pregnancy can be a bad combination not only for the mother but for her future child as well.

Researchers found that six-year-olds whose mothers were severely obese before pregnancy are more likely to have developmental or emotional problems than kids of healthy-weight mothers.

The lead author of the study, Heejoo Jo of the Centers for Disease Control and Prevention (CDC), and her team reviewed data on 1,311 mother-child pairs collected between 2005 and 2012, including the mothers’ body mass index (BMI, a height-to-weight ratio) before pregnancy and their reports of the children’s psychosocial difficulties at age six.

The researchers also incorporated the children’s developmental diagnoses and receipt of special needs services.

Kids of moms who were severely obese, with a BMI greater than 35, were twice as likely to have emotional symptoms, problems with peers and total psychosocial difficulties compared to kids of moms who had a healthy BMI, between 18.5 and 25.

Their children were three times as likely to have a diagnosis of autism spectrum disorder and more than four time as likely to have attention-deficit/hyperactivity disorder (ADHD), as reported in the journal Pediatrics.

Previous studies have shown a connection with autism and maternal diabetes and obesity.

Researchers took into account pregnancy weight gain, gestational diabetes, breastfeeding duration, postpartum depression and infant birth weight. None of these explained the apparent association.

“We already do know that obesity is related to health problems during pregnancy and throughout the lifetime,” Jo said. “I think this adds to that by suggesting that not only does severe obesity affect a woman’s health but the health of her future children.”

This study could not analyze the mechanism linking severe obesity and later risk for developmental problems, Jo noted.

“One theory that we could not look at and needs further research was some small studies have linked maternal obesity to increased inflammation, which might affect fetal brain development,” she told Reuters Health by phone.

While it sounds cliché because we’ve heard it so much; obesity in America has reached epidemic status. Almost 30 percent of Americans are obese and the prevalence of maternal obesity has risen rapidly in the last two decades.

In the USA, approximately 64% of women of reproductive age are overweight and 35% obese.

Women’s health specialists recommend that obese women considering pregnancy lose weight before they conceive to help reduce health risks for themselves as well as their child.

The Academy of Pediatrics recommends that all children be screened for developmental delay or disability at nine, 18 and 24 or 30 months of age.

Health experts strongly suggest that women who were obese or severely obese when they became pregnant make sure that their children receive these developmental screenings.

Sources: Kathryn Doyle, http://www.reuters.com/article/2015/04/28/us-obese-pregnancy-adhd-kids-idUSKBN0NJ2FC20150428

James R. O'Reilly, Rebecca M. Reynolds, http://www.medscape.com/viewarticle/776504

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Daily Dose

E-Cigarettes

1:30 to read

E- cigarettes which were a relatively obscure curiosity only 5 years ago are now available at not only “vape shops” but are also easy found at gas stations and pharmacies and the e-cigarette market has exploded. Unfortunately,  with the increased availability of e- cigarettes, there has been a steady rise in adolescent e-cigarette use (vaping).  

 

The Surgeon General stated, “exposing the developing brain to nicotine has been shown to alter its structure and function in a way that introduces long-lasting vulnerability for addiction to nicotine and other substances of abuse”. Yearly studies in high school students about their use of e-cigarettes showed that the percentage of students reporting e-cigarette use in the past 30 days went from 1.5% in 2011 to 16% in 2015.  The use of e-cigarettes by teens is becoming a major public health issue.

 

In a study recently reported in JAMA (Journal of the American Medical Association), 10th grade students were surveyed in the Los Angeles public schools and found that about 37% of 10th graders have used e-cigarettes. In the same study it was reported that “teens who vaped frequently were about 10 times more likely to become regular smokers six months later, compared to teens who never vaped”. Additionally, “20% of the regular e-cig users transitioned into frequent smokers, while less than 1% of kids who had never vaped smoked cigarettes at follow-up”. It would seem from this and other studies that e-cigarettes may serve as a “gateway” to smoking cigarettes.

 

Those teens who were more frequent “vapers” might sensitize their brain to the addictive effects of nicotine and find even more “pleasure” when they start using cigarettes and may progress to adult smokers.

 

The FDA published its “deeming” rule and regulatory authority over e-cigarettes in May of 2016, and banned the sale of e-cigarettes to minors, as well as requiring warning labels on e-cigs. But the FDA did not ban e-cigarette TV ads, nor did it address the role of flavoring in attracting youths to use e-cigarettes.  (flavors such as cotton candy and gummy bear - really targeting teens) . Youth oriented advertising, not only on TV, but in stores and on the internet must be addressed as well, as studies again show that greater exposure to ads is associated with higher odds of e-cigarette use. 

 

So…once again parents  and pediatricians)  need to be discussing the use of e-cigarettes, “vaping” and life long risk for nicotine addiction.   

Your Teen

Teenage Heavy Pot Use and Memory Loss

2:00

Teens who are heavy users of marijuana may be setting themselves up for memory loss and physical changes in the brain suggests a new study.

Researchers found that young adults who'd smoked pot heavily as teens performed worse on memory tests than their peers who'd never used the drug regularly. And on brain scans, they tended to show differences in the shape of the hippocampus -the part of the brain that is involved with forming, organizing and storing memory. 

The findings did not prove that heavy marijuana use caused the changes in the brain or memory dysfunction, but suggests that there could be a connection. The study was small and participants were only assessed once.

Matthew Smith, lead researcher and an assistant professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine, in Chicago, pointed out that other research has found a link between teenagers' heavy marijuana use and lingering memory problems, as well as a loss in IQ points. Similarly, brain-imaging studies have found that habitual pot smokers show differences in the volume and shape of the hippocampus, versus non-users.

The young adults had stopped smoking pot on an average of two years before participating in this study. Smith said that the brain changes and memory loss suggests that the effects may indicate long-term damage.

The current findings are based on 10 young adults who smoked pot heavily as teens -- usually daily, starting at 16 or 17, for an average of three years. Smith's team compared them with 44 young adults the same age, and from similar backgrounds, with no history of drug abuse.

Overall, the former marijuana users performed worse on a test where they had to listen to a series of stories, then remember as much information as possible a half-hour later.

Smith said he thinks the gap would be relevant in real life. "It would be similar to having a conversation, and then forgetting details 30 minutes later," he said.

The researchers also found a correlation between having an "oddly shaped" hippocampus and poorer memory performance, Smith said, though he added that does not prove the structural difference caused the memory issues.

Because teenager’s brain are still developing, Smith suggests that if young people want to smoke marijuana it might be best to wait until they are in their 20s before they start.

"The overall body of evidence is pretty clear that when teenagers use marijuana [regularly], their brains tend to look different and there tend to be cognitive differences," he said.

Not everyone agrees that this study points out a link between teenage heavy marijuana use with cognitive difficulties or hippocampus changes.

Paul Armentano, deputy director of NORML, a non-profit that advocates for legal marijuana use, says that because participants in the study were assessed only once, there’s no way to know whether the pot use came before any memory issues.

He also suggests other factors may be responsible for the hippocampus changes such as heavy drinking.

Armentano believes concerns about teenagers' developing brains presents a good argument for legalizing marijuana. "The obvious public-policy response," he said, "is to regulate the substance in a manner that better restricts young people's access to it, and provides them with evidence-based information in regard to its potential risks."

With the legalization of marijuana use in several states and other states looking at the possibility of legalization, more studies of the long-term effects are beginning to flow in.

Legalization certainly isn’t the beginning of pot use among teens. However, the perception of marijuana use as harmful is changing rather quickly among teens and even pre-teens.

According to www.drugabuse.gov, marijuana use remained stable in 2014, even though the percentage of youth perceiving the drug as harmful went down. Past-month use of marijuana remained steady among 8th graders at 6.5 percent, among 10th graders at 16.6 percent, and among 12th graders at 21.2 percent. Close to 6 percent of 12th graders report daily use of marijuana (similar to 2013), and 81 percent of them said the drug is easy to get.

Although marijuana use has remained relatively stable over the past few years, there continues to be a shifting of teens’ attitudes about its perceived risks. The majority of high school seniors do not think occasional marijuana smoking is harmful, with only 36.1 percent saying that regular use puts the user at great risk, compared to 39.5 percent in 2013 and 52.4 percent in 2009. However, 56.7 percent of seniors say they disapprove of adults who smoke it occasionally, and 73.4 percent say they disapprove of adults smoking marijuana regularly.

Waiting till a child has reached their pre-teen or teenage years to start discussing drug use isn’t going to be near as effective as beginning that conversation much earlier. Drugs have long held a fascination for kids whether you’re talking about marijuana, cigarettes, alcohol or any of the other type of inhalant or pills. That’s not news to parents. The difference is that drugs are now more easily available and new temptations are widespread.  

No matter what the research eventually reveals, drug use should be a topic that parents start discussing with their children when they are young- using age-appropriate terminology- along with the sex, personal responsibility and ethics discussions. These conversations can provide information that will help them navigate peer and societal temptations in a more mature and educated way.

Sources: Amy Norton, http://teens.webmd.com/news/20150312/teens-heavy-pot-smoking-tied-to-memory-problems

http://www.drugabuse.gov/publications/drugfacts/high-school-youth-trends

Your Child

The Virus That Is Making Lots of Kids Sick

2.00 to read

You may have heard about a fast-spreading virus that is sending children to emergency rooms around the country. It’s called enterovirus D68 or EV-D68 and was first discovered in 1962 in California.

Until now, the virus has been typically contained to small clusters around the U.S. But that is changing rapidly. Currently, most of the cases have been diagnosed in the Midwest and parts of the South. Because the virus is spreading quickly from area to area, it has gained the attention of the Centers for Disease Control and Prevention (CDC).

This is the first time it’s caused such widespread misery, and it seems to be particularly hard on the lungs.

What are the symptoms of EV-D68? Most viral infections start out with a fever, cough and runny nose, but D68 doesn’t seem to follow that classic pattern, says Mary Anne Jackson, MD She's the division director of infectious disease at Children’s Mercy Hospital in Kansas City, MO, the hospital where the first cases were identified.

“Only 25% to 30% of our kids have fever, so the vast majority don’t,” Jackson says. Instead, kids with D68 infections have cough and trouble breathing, sometimes with wheezing.

They act like they have asthma, even if they don’t have a history of it, she says. “They’re just not moving air.”

Who is at the greatest risk? Recent cases have been in children ages 6 months to 16 years, with most hovering around ages 4 and 5, the CDC says.

Usually the enterovirus strikes between July through October, so we are still in the virus season.

Many kids will experience milder symptoms, but children with a history of breathing problems can be hit particularly hard.

Two-thirds of those hospitalized at Children’s Mercy had a history of asthma or wheezing, Jackson says.

“We made sure that primary care providers are in touch with their patients with asthma, so those have an active asthma plan and know what to do if they get into trouble,” she says.

What treatments are available for EV-D68? Antibiotics don’t work because it is a virus and not bacteria. There is no vaccine available at this time or antiviral medication for treatment. It is treated with supportive care.

“The main thing is giving supplemental oxygen to the children who need it,” says Andi Shane, MD. medical director of hospital epidemiology and associate director of pediatric infectious disease at Children’s Healthcare of Atlanta. 

Children may also get medications, such as albuterol, which help relax and open the air passages of the lungs.

Those with the most critical cases have needed ventilators to help them breathe.

Most children who get EV-D68 will have a milder course of disease that tender loving care; rest and plenty of fluids will work as treatment.

However, it’s time to head to the doctor’s office or emergency room “if there’s any rapid breathing, and that means breathing more than once per second consistently over the span of an hour. Or if there’s any labored breathing,” says Roya Samuels, MD. She's a pediatrician at Steven & Alexandra Cohen Children’s Medical Center in New Hyde Park, N.Y.

Labored breathing, says Samuels, means kids are using smaller muscles around the chest wall to help move air in and out of their lungs.

“If you see the skin pulling in between the ribs or above the collarbone, or if there’s any wheezing, those are clear signs that a child needs to be evaluated,” she says.

You catch it basically like to catch any other virus. The enterovirus is pretty hardy and can live on surfaces for hours and as long as a day, depending on temperature and humidity.

The virus can be found in saliva, nasal mucus, or sputum, according to the CDC.

Touching a contaminated surface and then rubbing your nose or eyes is the usual way someone catches it. You can also get it from close person-to-person contact.

Protect yourself with good hand-washing habits. Tell kids to cover their mouth with a tissue when they cough. If no tissue is handy, teach them to cough into the crook of their elbow or upper sleeve instead of their hand.

The good news is that common disinfectants and detergents will kill enteroviruses. Cleaning surfaces that are frequently touched by everyone in the household is important to help keep the virus from spreading. For children, be sure to include toys, cups and doorknobs. While sick children are gaining most of the media attention, adults can also catch EV-D68. 

The virus may be spreading farther than currently known because it is not always tested for when a child enters the hospital or clinic for help.

Again, many children will only experience milder symptoms and will not need to be hospitalized, but if your child exhibits symptoms that include trouble breathing; take them to a doctor immediately.

Source: Brenda Goodman, MA and Hansa D. Bhargava, MD, http://www.webmd.com/cold-and-flu/news/20140909/enterovirus-d68-parents

Your Child

Antibiotics Often Prescribed When Not Needed

2.00 to read

By now, most parents understand that antibiotics are not effective for viral infections, only for illnesses caused by bacteria.

However, that hasn’t deterred many physicians from over-prescribing antibiotics for children with ear and throat infections.

More than 11 million antibiotic prescriptions written each year for children and teens may be unnecessary, according to researchers from University of Washington and Seattle Children's Hospital. This excess antibiotic use not only fails to eradicate children's viral illnesses, researchers said, but also supports the dangerous evolution of bacteria toward antibiotic resistance.

"I think it's well-known that we prescribers overprescribe antibiotics, and our intent was to put a number on how often we're doing that," said study author Dr. Matthew Kronman, an assistant professor of infectious diseases at Seattle Children's Hospital.

"But as we found out, there's really been no change in this [situation] over the last decade," added Kronman. "And we don't have easily available tools in the real-world setting to discriminate between infections caused by bacteria or viruses."

 Doctors have limited resources when it comes to differentiating between bacterial or viral infections. Physicians can use the rapid step test to determine if the streptococcus bacteria is the cause of a child’s sore throat, but that is about it for immediate diagnostic tools.

Most colds are virus related and one of the first symptoms will be a sore or scratchy throat. It will typically go away after the first day or so and other cold symptoms will continue. Strep throat is often more severe and persistent.

A virus often causes ear infection as well. Many doctors treat ear infections as though they are bacterial to be on the safe side and avoid serious middle ear infections.

To determine antibiotic prescribing rates, Kronman and his colleagues analyzed a group of English-language studies published between 2000 and 2011 and data on children 18 and younger who were examined in outpatient clinics.

Based on the prevalence of bacteria in ear and throat infections and the introduction of a pneumococcal vaccine that prevents many bacterial infections, the researchers estimated that about 27 percent of U.S. children with infections of the ear, sinus area, throat or upper respiratory tract had illnesses caused by bacteria.

But antibiotics were prescribed for nearly 57 percent of doctors' visits for these infections, the study found.

Kronan hopes that the study’s results will encourage the development of more diagnostic tools and will spur doctors to think more critically about prescribing antibiotics unless clearly needed.

Previous research has shown that parents often pressure their doctor to prescribe an antibiotic to treat their child’s ear or sore throat symptoms. However, when parents are given other suggestions on how to alleviate the symptoms they have been much more receptive than when their doctor just flat out says he won’t prescribe antibiotics.

Many physicians and researchers are concerned that the amount of antibiotics being prescribed these days is setting us all up for future problems when dealing with bacterial infections. Bacteria are adaptable and mutate over time becoming less responsive to antibiotics. When possible, it’s much healthier in the long run to treat your child’s symptoms with simpler therapies. Ask your physican ways you can make your little one more comfortable until the symptoms pass. 

The study was published online in the journal Pediatrics.

Source: Maureen Salamon, http://consumer.healthday.com/infectious-disease-information-21/antibiotics-news-30/antibiotics-prescribed-twice-as-often-as-needed-in-children-study-says-691686.html

Your Baby

Preparing for Twins or Triplets

1:45

The number of U.S. parents expecting twins and triplets has reached an all-time high according to the National Center for Health Statistics. Multiple births make up a small portion of births in general, but since 1980, multiples numbers have been on the rise.

The number of twins born in the U.S. has increased the most. Along with twice the cuteness comes twice the workload. The American Academy of Pediatrics (AAP) offers parents of multiples some handy preparation tips:

Keep in mind that "multiples" are often born early and tend to be smaller than the average newborn. The AAP says parents may need to visit with their pediatrician more often than usual and reach out for help with feeding concerns or strategies.

And then there are the diapers- lots and lots of diapers! Go ahead and start purchasing your diapers ahead of time. The more you have stocked away before your little ones are born, the less worries you’ll have about running out when you need them most. Also, you’ll be able to gage about how many you’ll need when you start shopping again.

Having multiples also means fitting more safety seats into the car, more clothing, more food and possibly even a larger home! Check out how well your home is going to work for a larger family and plan accordingly.

One of the most important things for parents to consider is making sure that each child has their own identity. Multiples may share everything, but they are individuals and should be raised as such, the AAP advises. Identical twins, in particular, may seem like a duo, and parents might be tempted to give them the same things and the same amount of attention. But even genetically identical children have different personalities, thoughts and emotions. The AAP urges parents to acknowledge and support their differences to help them become happy and secure individuals.

If you have other children, remember they need special attention too. It’s easy to overlook the older kids when the new kids on the block are demanding so much attention.

As multiples grow, they may form exclusive bonds and may even communicate in a way only they can understand. Sometimes, they become unwilling to seek out other friendships. Giving multiples some time apart can help them develop friendships and ensure that other siblings aren't left out, the academy says.

And efforts to encourage multiples to spend time apart should start early to head off resistance. Most elementary schools place multiples in separate classes, the news release noted. Parents who are concerned about preventing separation anxiety can turn to their pediatrician for advice.

Don’t be afraid to ask for help! Multiples demand a lot of attention. If your budget allows, hire someone to clean the house a few days a week. Grandparents, uncles and aunts, brothers and sisters may be willing to pitch in and give you some much needed down time or date time.  Don’t forget about your friends – while you may think it’s too much of an imposition, they may love being able to spend some quality time with your children – then turn them back over to you!

Take turns getting up at night for feedings and changings. Giving your spouse a few hours of uninterrupted sleep will do wonders for your relationship.

There’s a lot to prepare for when multiples are involved but the rewards are great. It may feel a little overwhelming at first, but eventually you will figure out a routine that works for everyone.

Story source: Mary Elizabeth Dallas, https://consumer.healthday.com/women-s-health-information-34/birth-health-news-61/having-twins-or-triplets-what-you-need-to-know-before-they-arrive-715653.html

http://www.pewresearch.org/fact-tank/2015/12/11/twins-triplets-and-more-more-u-s-births-are-multiples-than-ever-before/

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