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Daily Dose

Kids & Cellphones

1:30 to read

There is a new study out from the National Toxicology Program in which rats were exposed to radio frequency radiation for nine hours a day for two years beginning in utero.  They compared these rats to those that were not exposed and interestingly some of the male rats developed tumors in their hearts and brains and the controls did not.

I am writing about this as another deterrent to giving children a cell phone at a young age and for not having a home phone. While it is too early to say if this study has any bearing on humans and obviously the exposure was heavier than normal, this may serve as another deterrent to giving children a cell phone at a young age. It may also help to bring “land lines” back into the home. 

Call me old school, but I continue to believe and counsel patients, having a home phone is still important.  Without a home phone how can you call your child when you are away and they may be home with a babysitter….and not depend on the caregivers cell phone?  I also think that some children may be ready to stay at home for 30 min to an hour at a time while their parents go to the store, or pick up a sibling from school etc. before they are ready for a cell phone. By having a home phone the child has a means of contacting their parents, neighbors or emergency personnel and don’t risk losing a cell phone or any of the other numerous issues associated with owning a cell phone.

A home phone also gives children an opportunity to learn how to answer a phone and begin “screening” phone calls for the family and to learn phone etiquette….which is not always taught when parents are answering the cell and handing it off to their child.  What about the days when we were taught to say “Hello, Hubbard residence” when answering the phone?  Or having your mother sit by your side while you called a friend’s house and started off the conversation with, “may I please speak to…Sally?”. Phone etiquette was such an important part of every child’s life.

Once your child does have a cell phone it also seems that they may spend more time isolated from the family when on the phone….and may spend longer amounts of time on the phone than when the phone was in the family kitchen. Even my grown children often go outside to take their cell phone call….wonder what they are talking about, me?  I digress….

The American Academy of Pediatrics continues to recommend that parents should limit the use of cell phones by children and teens. A cell phone is not a toy and emits radiation.  Keeping this source of radiation away from our children for as long as possible seems prudent while more research continues…and this study just gives parents a bit more ammunition when their 6 year old starts off with, “everyone else has a cell phone…when can I have one?”.  


Daily Dose

New Concussion Guidelines

1:30 to read

A really interesting study was published in Pediatrics online entitled “Benefits of Strict Rest After Acute Concussion”.  The guidelines for treating a concussion continue to be debated and that is what makes this study thought provoking.  

This was a “randomized controlled study”  which followed 88 patients between the ages of 11 and 22 years who had been diagnosed with a concussion.  45 of the patients were given instructions for 5 days of strict rest at home with no school, no work and no physical activity.  They were then allowed to have a “stepwise return to activity”.  The other 43 patients were told to “rest” for 1-2 days after which time they could  return to school also follow a “stepwise return to activity”.

Interestingly, there was no clinically significant difference in the  neurocognitive or balance outcomes between the two groups.  In fact the group that was “advised to rest for 5 days” reported more daily post concussive symptoms and slower resolution of symptoms than those who were told to rest for 1-2 days.  

This was a small study and does not mean that everyone should be treated the same way. In fact, when seeing a patient who has sustained a concussion each person seems to be a bit one could expect when discussing a “brain injury”.  No two brains are exactly least for the time being...who knows what will happen one day with genetics

In my own limited practice I have found that “very few” tweens and teens subscribe to the complete rest theory...that is no school, but also no TV, no computer and no videos or smart phones....WHAT??? No social media for 5 days?  You would have to put most of them on an isolated “post concussion island” to ensure they disconnect.  

The study authors also wondered if patients reported more symptoms after having strict rest recommended.  It seems plausible that I too might notice a few more symptoms when just sitting there wondering if my head hurts or if I seem to be more fatigued.

Subjective symptoms are always difficult to quantify...which makes treating a concussion more problematic.  I think erring on the conservative side and restricting “return to play” for a longer period seems to be of more importance than any other recommendation, including “5 days of strict rest”. In the meantime this is an interesting study....with more data to surely follow. 


Your Teen

What do Energy Drinks Actually Do to the Body?


There’s been a lot of discussion over whether caffeine-spiked “Energy Drinks” are really safe for consumption, particularly for kids and young adults.  Although many manufacturers add the advisory statement “not recommended for children, pregnant or nursing women and persons sensitive to caffeine” on their label, it often goes ignored.

The Substance Abuse and Mental Health Services Administration reports that as these drinks have become more popular, the incidences of caffeine related overdoses and deaths have increased.

In one heartbreaking example, 14-year-old Anais Fournier died from cardiac arrest due to caffeine toxicity after consuming two 24- ounce cans of Monster energy drink a day apart.

While the Food and Drug Administration (FDA) has been investigating whether there is causal link to the drinks and health problems, Mayo Clinic researcher Anna Svatikova and her colleagues wanted more information about exactly what happens in your body after you consume one of the drinks.

She and her team recruited 25 volunteers. All were young adults age 18 or older, nonsmokers, free of known disease, and not taking medications. They were asked to drink a 16-ounce can of a Rockstar energy drink and a placebo -- with the same taste, texture, color and nutritional contents but without the caffeine and other stimulants -- within five minutes on two separate days.

The energy drink had the following stimulants: 240 mg of caffeine, 2,000 mg of taurine and extracts of guarana seed, ginseng root and milk thistle. All typical ingredients associated with energy drinks.

Researchers took numerous measurements first before they drank and 30 minutes after. With the placebo, there was very little change. With the energy drink, however, many of the changes were marked:

•       Systolic blood pressure (the top number) - 6.2 percent increase

•       Diastolic blood pressure (the bottom number) - 6.8 percent increase

•       Average blood pressure - 6.4 percent increase

•       Heart rate - none

•       Caffeine in blood - increase from undetectable to 3.4 micrograms/mL

•       Norepinephrine level (the stress hormone, which can give you the shakes when you have too much caffeine) in blood - increase from 150 pg/mL to 250 pg/ML

Writing in JAMA, the researchers said that these changes may predispose those who drink a single drink to increased cardiovascular risk.

This may explain why a number of those who died after consuming energy drinks appeared to have had heart attacks.

They also exposed the volunteers to two-minute physical, mental, and cold stressors after consuming the energy drinks to see how that might affect blood pressure and other body functions.

The physical stressor involved asking participants to squeeze on a handgrip; the mental one to complete a series of mathematical tasks as fast as possible; and the cold one immersing their one hand into ice water. Interestingly, there was no further change.

Another thing that is typically overlooked when people choose one of these drinks is the serving size. A 16-ounce can is two servings. A 24-ounce can has three servings. Caffeine and sugar content is often listed per serving. But honestly, how many people drink a third or half a can at a time? Besides caffeine, other stimulants are often added to energy drinks such as Ginseng and Guarana. Most people have no idea what they are, what they do and if they negatively interact with medications.

The American Beverage Association defends the drinks and said in a statement  that "there is nothing unique about the caffeine in mainstream energy drinks, which is about half that of a similar sized cup of coffeehouse coffee" and that drinking coffee would have produced similar effects.

“The safety of energy drinks has been established by scientific research as well as regulatory agencies around the globe. Just this year the European Food Safety Authority (EFSA) confirmed the safety of energy drinks and their ingredients after an extensive review," the organization said.

It’s up to parents to decide whether these drinks are beneficial to their family or if they should re-think purchasing one for themselves or their child. A family discussion about the pros and cons of energy drinks with pre-teens and teenagers could give the kids the information they need to make a good choice.

Source: Ariana Eunjung Cha,

Your Baby

Eating Fish During Pregnancy Benefits Baby’s Brain Development


Can eating more fish during pregnancy help babies’ brains function better as they grow older? Yes, according to a new study from Spain. The researchers say that mothers who eat three substantial servings of fish – each week- during pregnancy may be giving their children an advantage as they mature.

Researchers followed nearly 2,000 mother-child pairs from the first trimester of pregnancy through the child’s fifth birthday and found improved brain function in the kids whose mothers ate the most fish while pregnant, compared to children of mothers who ate the least.

Even when women averaged 600 grams, or 21 ounces, of fish weekly during pregnancy, there was no sign that mercury or other pollutants associated with fish were having a negative effect that offset the apparent benefits.

“Seafood is known to be an important source of essential nutrients for brain development, but at the same time accumulates mercury from the environment, which is known to be neurotoxic,” lead author Jordi Julvez, of the Center for Research in Environmental Epidemiology in Barcelona, said in an email to Reuters Health.

This important health concern prompted the U.S. Food and Drug Administration (FDA) to come up with a guideline for pregnant women in 2014. It encourages women to eat more fish during pregnancy, but limit the intake to no more than 12 ounces per week.

For this study, researchers analyzed data from the Spanish Childhood and Environment Project, a large population study that recruited women in their first trimester of pregnancy, in four provinces of Spain, between 2004 and 2008.

Julvez and colleagues focused on records of the women’s consumption of large fatty fish such as swordfish and albacore tuna, smaller fatty fish such as mackerel, sardines, anchovies or salmon, and lean fish such as hake or sole, as well as shellfish and other seafood.

Women were tested for blood levels of vitamin D and iodine, and cord blood was tested after delivery to measure fetal exposure to mercury and PCB pollutants. At ages 14 months and five years, the children underwent tests of their cognitive abilities and Asperger Syndrome traits to assess their neuropsychological development.

On average, the women had consumed about 500 g, or three servings, of seafood per week while pregnant. But with every additional 10 g per week above that amount, children’s test scores improved, up to about 600 g. The link between higher maternal consumption and better brain development in children was especially apparent when kids were five.

The researchers also saw a consistent reduction in autism-spectrum traits with increased maternal fish consumption.

Mothers’ consumption of lean fish and large fatty fish appeared most strongly tied to children’s scores, and fish intake during the first trimester, compared to later in pregnancy, also had the strongest associations.

“I think that in general people should follow the current recommendations,” Julvez said. “Nevertheless this study pointed out that maybe some of them, particularly the American ones, should be less stringent.”

Julvez noted that there didn’t appear to be any additional benefit when women ate more than 21 ounces (about 595 g) of fish per week.

“I think it's really interesting, and it shed a lot more light on the benefits of eating fish during pregnancy,” said Dr. Ashley Roman, director of Maternal Fetal Medicine at NYU Langone Medical Center in New York.

“I think what's interesting about this study compared to some data previously is that they better quantify the relationship between how much fish is consumed in a diet and then the benefits for the fetus and ultimately the child,” said Roman, who was not involved in the study.

Roman also noted that pregnant women should avoid certain fish such as tilefish, shark, swordfish and giant mackerel. These are larger fish with longer life spans that may accumulate more mercury in their tissue.

While fish may be a great source of protein and benefit brain development in utero, most experts agree that women should consult their obstetrician about what fish are safer to eat and how much they should eat during pregnancy.

The study was published online in the January edition of the American Journal of Epidemiology

Source: Shereen Lehman,




Your Child

Healthier Choices for Students in School Lunch Lines


School lunches have changed over the years and in many school cafeterias, food options are healthier than ever before, according to a new study.

Elementary school cafeterias are offering more vegetables, fresh fruit, salad bars, whole grains and more healthy pizzas, while the availability of high-fat milks, fried potatoes and regular pizza has decreased, researchers report.

"School food service programs have worked hard to improve the nutritional quality of school lunches, and largely have been very successful," said lead researcher Lindsey Turner, director of the Initiative for Healthy Schools at Boise State University, in Idaho.

Although in some schools food choices are improving, that’s not the case everywhere. Turner noted that more work needs to be done to make sure every student has the same healthy choices in the lunch line.

In the study of more than 4,600 elementary schools that are part of the U.S. National School Lunch Program, researchers found that school lunches improved significantly between 2006-2007 and 2013-2014.

Despite improvements in food choices, disparities were still found. For example, schools in the West were more likely to offer salad bars than schools in the Northeast, Midwest or South, the researchers found.

Schools with a majority of black or Hispanic children were less likely to offer fresh fruit than schools with a preponderance of white students.

Also, schools in poor areas were less likely to offer salads regularly.

Over the course of the study, Midwestern schools slightly reduced offering pre-made salads in favor of salad bars, but Southern schools were more likely to offer pre-made salads and less likely to have salad bars, the researchers found.

On the other side of offering healthier foods is choosing to eat those foods. Just because there are better food options available, doesn’t mean that kids will eat them. One expert noted that it takes time and effort for kids to change their eating habits. It not only has to look good, it has to taste good.

"It is not only important to improve the quality of school lunches but to make these foods attractive, tasty, easily seen and accessible," said Samantha Heller, a senior clinical nutritionist at New York University Medical Center, in New York City.

Studies have found that putting fresh fruit in a nice bowl, in a conveniently located, well-lit area in the school cafeteria increased sales of fruit by 102 percent, she noted.

"A brightly lit, hot-and-cold salad bar filled with colorful fresh fruits, vegetables, beans and nuts, mushroom and spinach pizza, and veggie tacos center-stage in the lunchroom would be very attractive to students and staff alike," Heller said.

This approach works well at home, too, she added.

"Kids are more likely to grab healthy foods like cut-up melon, carrots, peppers, edamame and hummus when they are upfront and easy to grab in the fridge," Heller said.

The study was published in the journal Preventing Chronic Disease.

Story source: Steven Reinberg,

Your Baby

No Link Found Between Induced Labor and Autism


In 2013, a study suggested there might be a link between induced labor using a medication such as oxytocin, and a higher risk of the baby developing autism.  New research out of Boston, Massachusetts says there is no connection between the two.

"These findings should provide reassurance to women who are about to give birth, that having their labor induced will not increase their child's risk of developing autism spectrum disorders," said senior researcher Dr. Brian Bateman. He's an anesthesiologist at Massachusetts General Hospital and Brigham and Women's Hospital in Boston.

Induced labor is sometimes needed when a mother’s labor stalls or the infant is endangered. Because of the former study, many women have had concerns about labor induction and the risk of autism.

Bateman's team of American and Swedish researchers, led by the Harvard T. H. Chan School of Public Health, decided to investigate the issue.

They used a database on all live births in Sweden from 1992 through 2005, and looked at child outcomes for more than 1 million births through 2013, to identify any children diagnosed with a neuropsychiatric condition.

They also identified all the children's brothers, sisters and cousins on their mother's side of the family. The health of the children's mothers was also taken into account.

Eleven percent of the inductions were due to health complications such as preeclampsia, diabetes or high blood pressure. Twenty-three percent were induced because of late deliveries (after 40 weeks of pregnancy).

Results showed that 2 percent of the babies in the study were later diagnosed with autism.

When just looking at unrelated children, the researchers did find a link between induced labor and a greater risk for an autism spectrum disorder. This association disappeared, however, once they also considered the women's other children who were not born from an induced labor.

"When we used close relatives, such as siblings or cousins, as the comparison group, we found no association between labor induction and autism risk," said study author Anna Sara Oberg, a research fellow in the department of epidemiology at the Harvard Chan School.

Explaining further, she said in a university news release, "many of the factors that could lead to both induction of labor and autism are completely or partially shared by siblings -- such as maternal characteristics or socioeconomic or genetic factors." Therefore, Oberg said, "previously observed associations could have been due to some of these familial factors, not the result of induction."

Other experts have agreed with the new study’s findings.

"Pregnant women have enough things to worry about," said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children's Medical Center of New York, in New Hyde Park, N.Y.

"If a woman's doctor recommends that labor be induced, the expectant mother should not worry about an increased risk of the child having an autism spectrum disorder," Adesman said.

If you have concerns about a connection between labor induction and autism, speak to your OB/GYN to learn more. 

The study was published in  in the July 25th online edition of JAMA Pediatrics.

Story source: Mary Elizabeth Dallas,


Your Teen

What Is the Most Common and Deadly Cancer Found in Teens?


Do you know the most common and deadly cancer found in teens and young adults? You may be as surprised as I was when I read that a new study shows it is brain cancer.  It’s also not a particular type of brain cancer, but can vary widely as people age.

"For these individuals -- who are finishing school, pursuing their careers and starting and raising young families -- a brain tumor diagnosis is especially cruel and disruptive," said Elizabeth Wilson, president and CEO of the American Brain Tumor Association (ABTA).

"This report enables us for the first time to zero in on the types of tumors occurring at key [age] intervals over a 25-year time span, to help guide critical research investments and strategies for living with a brain tumor that reflect the patient's unique needs," Wilson said in an association news release.

Researchers look at data from 51 separate cancer registries, representing 99.9 percent of the U.S. population in the 15 to 39 year-old-age group.

While 2 types of tumors were the most frequently found in this age group, brain and central nervous system tumors, the report also noted that other types of cancer became more prevalent as people got older.

"What's interesting is the wide variability in the types of brain tumors diagnosed within this age group, which paints a much different picture than what we see in [older] adults or in pediatric patients," said report senior author Jill Barnholtz-Sloan, an associate professor at Case Western's Comprehensive Cancer Center in Cleveland.

"For example, the most common tumor types observed in adults are meningiomas and glioblastomas, but there is much more diversity in the common tumor types observed in the adolescent and young adult population," Barnholtz-Sloan said in the news release.

"You also clearly see a transition from predominantly nonmalignant and low-grade tumors to predominantly high-grade tumors with increasing age," she added.

Nearly 700,000 people in the United States have brain and central nervous system tumors. And more than 10,600 such tumors are diagnosed in teens and young adults each year, with 434 dying of their disease annually, according to the ABTA.

The most common treatment for brain cancer continues to be surgery, radiation and chemotherapy. However, new research is looking into the development of tailored therapeutics involving a combination of targeted agents that use different molecules to reduce gene activity and suppress uncontrolled growth by killing or reducing the production of tumor cells based on their genetic character. Experimental treatment options may include new drugs, gene-therapy and biologic modulators that enhance the body’s overall immune system to recognize and fight cancer cells.

"There are clearly unique characteristics of the 15-39 age group that we need to more comprehensively understand, and the information in the ABTA report starts that important dialogue," Barnholtz-Sloan said.

The ABTA-funded report was recently published in journal Neuro-Oncology.

Story source: Robert Preidt,

Your Baby

Eating Chocolate While Pregnant May Improve Mom and Baby’s Health!


 Put another check in the win column for a reason to eat chocolate - as though anyone really needs one!

 A new study suggests that moms-to-be that eat a small piece of chocolate every day may improve their baby’s cardiovascular health and reduce the risk for preeclampsia.

 Researchers found that their findings held up regardless of whether the chocolate consumed contained high or low amounts of flavonoids, a group of phytochemicals that have antioxidant abilities. Various studies have also suggested that flavonoids may offer heart health benefits.

 As with most studies, the research did not prove that eating chocolate during pregnancy caused better circulatory health in pregnant women and their babies, only that there was an association.

 "Our observations suggest that a regular small consumption of dark chocolate -- whether or not the level of flavanol is high -- from the first trimester of pregnancy, could lead to an improvement of placental function," said study author Dr. Emmanuel Bujold. He is a professor of obstetrics and gynecology at Universite Laval in Quebec City, Canada.

 Bujold's team decided to see whether differences in flavanol content had any effect on the pregnancies of nearly 130 women.

 All of the women in the study were at the 11- to 14-week mark of their pregnancy, and carrying one child.

 All were instructed to consume 30 grams of chocolate (a little more than one ounce) each day over a 12-week period. That's equivalent to about one small square of chocolate per day, Bujold said.

 Half of the women consumed high-flavanol chocolate, while the other half was given low-flavanol chocolate. All were then tracked until their delivery date.

 Regardless of which type of chocolate was consumed, the women faced the same risk for both preeclampsia and routine high blood pressure. Placental weight and birth weight was also the same in both groups, the investigators found.

 Similarly, fetal and placental blood circulation levels, as well as in-utero blood velocity, did not appear to be affected by shifting flavanol levels.

 However, simply consuming a small amount of chocolate -- no matter what the flavanol content -- was associated with notable improvements in all blood circulation and velocity measures compared to the general population, the researchers said.

 Bujold said this suggests that there's something about chocolate, apart from flavanol levels, that may exert a positive influence on the course of pregnancy. Finding out exactly what that is "could lead to improvement of women's and children's health, along with a significant reduction of treatment cost," he said.

 While that’s good news for chocolate lovers, Bujold cautions that pregnant women keep the portion small and calorie intake low.

 So, a bit of chocolate daily while pregnant is not going to hurt you, in fact it just may give you and your baby’s health a little boost.

 The findings were scheduled for presentation at the Society for Maternal-Fetal Medicine's annual meeting, in Atlanta. The data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

 Source:  Alan Mozes,

Your Teen

Schools Start Too Early, Teens Sleep Deprived


It’s a battle that is picking up steam, whether to start school a little later so teenagers can get the sleep they need or keeping schedules as they are for the sake of planning before and after school activities.

Research from the American Academy of Pediatrics (AAP) found that teenagers are biologically programmed to go to bed later than most adults and sleep later in the morning.

Last year, the AAP issued a set of guidelines recommending that school schedules are modified across the U.S. to start at 8.30 a.m. This way, children and teens would be able to meet the recommended sleep hours per night during school days.

Fewer than one in five middle and high schools in the United States start at 8:30 am or later, as recommended, according to data from the U.S. Centers for Disease Control and Prevention (CDC).

The same recommendations suggested that indeed, the biological rhythm of teenagers particularly is very different than that of adults. While they need 8 and a half to nine and a half hours of sleep per night, their circadian rhythm doesn’t allow them to go to sleep before midnight or a little after.

School nights are particularly difficult for adolescents because in order to get the rest they need, they have to go to bed earlier than their minds and bodies are set to fall asleep.

The CDC released a new study supporting the recommendations of the AAP. According to the findings, 83 percent of U.S. schools still start before 8:30 a.m. On average, the starting time was calculated at 8:03 a.m., based on data collected from 39,700 combined schools, middle schools, and high schools between 2011-2012.

Depriving teens of that sleep could wreak havoc on their academic performance, the CDC said in its Morbidity and Mortality Weekly Report.

"Getting enough sleep is important for students' health, safety, and academic performance," said Anne Wheaton, lead author and epidemiologist in CDC's Division of Population Health.

"Early school start times, however, are preventing many adolescents from getting the sleep they need."

The issue is driving a heated debate between supporters of later school start times and school administrators.

Safwan Badr, former president of the American Academy of Sleep Medicine stated:

“It makes absolutely no sense. You’re asking kids to learn math at a time their brains are not even awake”.

On the other hand, Daniel Domenech, the executive director of the School Superintendents Association stated with regards to changing school starting time:

“It’s a logistical nightmare. This has been going on forever, and kids have been graduation from school and going to college. It certainly doesn’t seem to have hurt them all these years”.

Some experts note that the long-term consequence of sleep deprivation is hurting our teens and has been for quite some time.

Judith Owens, the director of sleep medicine at Boston’s Children Hospital suggests that chronically sleep deprivation characterizes the majority of today’s teens. This results in increased risk of onset depression, substance abuse, unhealthy BMIs. Long-term effects of sleep deprivation result in type 2 diabetes or heart diseases.

There are things that parents can do to help their teens at least rest better if they can’t fall asleep earlier. The first and foremost agitator for sleep is viewing or being on a computer or smartphone right before bed.

Recent studies have shown that the use of any electronic device in the hour before bedtime was associated with an increased risk of taking longer than 60 minutes to fall asleep. In particular, the use of a computer, smartphone or MP3 player in the hour before bedtime was strongly linked with taking longer to fall asleep.

Make your teen’s bedroom a quiet place that can be a retreat at night from busy schedules and social media.

Your teen can take a hot bath or shower before bed to boost deep sleep. Then keep his or her room cool (about 68 F) to cool down the body. One study showed that sleep happens when the body cools. Wakefulness occurs when the body temperature warms up.

Aromatherapy helps some people fall off to sleep. Certain scents are shown to be relaxing such as orange blossom, marjoram, chamomile, and lavender. You can apply these oils before bed or put them on pillows, sheets or in potpourri. If candles are used, make sure they are put out before getting in bed. 

Having a regular schedule can help the body adjust. Going to bed at the same time each night can assist in adjusting the body’s circadian rhythm.  

More high schools are considering changing their schedules to a later start time, but currently most schools are keeping with the typical earlier schedules. You may not be able to convince the school board to start school at little later, but you can help your teen find what works for them at night to help them get the amount of sleep they need to function at their best.

Sources: Bonnie Gleason,





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