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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 different.....as one could expect when discussing a “brain injury”.  No two brains are exactly alike...at 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 Child

Trying to Guilt Kids into Exercising Doesn’t Work

1:45

 

Experts often discuss how kids aren't getting the proper amount of exercise they need to be healthy. But, trying to guilt children into exercising often results in the opposite desired effect according to a new study.

Researchers from the University of Georgia found that middle school students were less likely to be physically active if they didn't feel in control of their exercise choices or if they felt pressured by adults to get more exercise.

Kids who felt that whether they exercised or not was their own choice were much more likely to choose to exercise, the researchers said.

"Can we put these children in situations where they come to value and enjoy the act of being physically active?" lead author Rod Dishman, a professor of kinesiology, said in a university news release.

Dishman and his colleagues said they are looking for ways to help more children identify themselves as someone who likes to exercise.

"Just like there are kids who are drawn to music and art, there are kids who are drawn to physical activity. But what you want is to draw those kids who otherwise might not be drawn to an activity," Dishman said.

So how do you get your child to exercise? Make it about fun, not exercise says Dishman..

“The best thing is to do it because it's fun. It's the kids who say they are intrinsically motivated who are more active than the kids who aren't," Dishman concluded.

Children's activity levels typically fall 50 percent between fifth and sixth grades, the authors noted in the September issue of the journal Medicine & Science in Sports & Exercise.

Using guilt as a motivator seldom achieves the desired result, no matter whether it’s exercising or any other choice. Playing the guilt card with kids only makes them resent what you are trying to get them to do and more often than not, they will do the opposite.

Building a lifetime of healthy choices never began with a guilt trip. Being creative and adding an element of fun and challenge will achieve more than coercion through guilt. 

Children need to identify themselves as someone who wants to exercise instead of someone forced to exercise. The best results have been achieved when families make exercise a part of their daily routine and treat it like anything else they enjoy doing together.

Source: Robert Preidt, http://www.webmd.com/children/news/20150923/want-your-kids-to-exercise-skip-the-guilt

 

Your Child

Skin Cancer Risk Higher for Redheaded and Fair Skin Children

1:45

Too much exposure to sunlight can damage the skin, particularly for children who have pale skin, red or fair hair, freckles or the type of skin that sunburns easily. 

Researchers found that having the genes that give you red hair, pale skin and freckles increases your risk of developing skin cancer as much as an extra 21 years of sun exposure.

Their study found gene variants that produce red hair and freckly, fair skin were linked to a higher number of mutations that lead to skin cancers. The researchers said even people with one copy of the crucial MC1R gene - who may be fair-skinned but not have red hair - have a higher risk.

"It has been known for a while that a person with red hair has an increased likelihood of developing skin cancer, but this is the first time that the gene has been proven to be associated with skin cancers with more mutations," said David Adams, who co-led the study at Britain's Wellcome Trust Sanger Institute.

"Unexpectedly, we also showed that people with only a single copy of the gene variant still have a much higher number of tumor mutations than the rest of the population."

Redheads have two copies of a variant of the MC1R gene which affects the type of melanin pigment they produce, leading to red hair, freckles, pale skin and a strong tendency to burn in the sun.

Exposure to ultraviolet light from either the sun or sunbeds causes damage to DNA and scientists think the type of skin pigment linked to redheads may allow more UV to reach the DNA.

In this latest study, the researchers found that while this may be one factor in the damage, there are also others linked to the crucial MC1R gene.

Although skin cancer is rare in children, the amount of sun exposure during childhood is thought to increase the risk of developing skin cancer in adult life. Children who have had episodes of sunburn are more likely to develop skin cancers in later life.

The skin of children is more delicate and more prone to damage. Therefore, take extra care with children, and keep babies out of the sun completely.

Because infants’ skin is so sensitive, it’s better in the first six months to shield them from the sun rather than use sunscreen. It’s especially important to avoid direct sun exposure and seek the shade during the sun’s hours of greatest intensity, between 10 AM and 4 PM. Keep to the shady side of the street on walks, and use the sun shield on your stroller

Once your baby reaches 6 months of age, it’s time to introduce sunscreens. Choose a broad-spectrum, water-resistant sunscreen that offers a minimum sun protection factor (SPF) of 15. Look at the active ingredients; zinc oxide and titanium dioxide are good choices, because these physical filters don’t rely on absorption of chemicals and are less apt to cause a skin reaction. Test your baby’s sensitivity to the sunscreen first, by applying a small amount on the inside of baby’s wrist.

Toddlers should also be kept in the shade between 10 AM-4 PM. Protect young children with sunscreen, hats, sunglasses and lightweight clothing that covers the skin.

The study was published in the journal Nature Communications.

Most kids get much of their lifetime sun exposure before age 18, so it's important for parents to teach them how to enjoy fun in the sun safely. Taking the right precautions can greatly reduce your child's chance of developing skin cancer.

Story sources: http://patient.info/health/preventing-skin-cancer

http://www.foxnews.com/health/2016/07/12/skin-cancer-risk-for-freckly-red-heads-equivalent-to-21-years-in-sun.html

http://www.skincancer.org/prevention/sun-protection/children/oh-baby

 

 

Your Child

New Guidelines for Tonsillectomies

Most children who get repeated throat infections probably don’t need surgery to remove their tonsils and would improve in time with careful monitoring, according to new clinical guidelines on tonsillectomies in children.

The new guidelines also suggest, however, that removal of the tonsils, or tonsillectomy, may improve problems tied to poor sleep, including bed-wetting, slow growth, hyperactive behavior, and poor school performance. In fact, sleep-disordered breathing -- a set or problems that range from snoring to obstructive sleep apnea - is now the most common reason for tonsil removal in kids younger than 15. “We used to think that only if you were an air traffic controller did it matter if you slept well or not, and now we know that’s not the case,” says Amelia F. Drake, MD, chief of the division of pediatric otolaryngology at the University of North Carolina School of Medicine in Chapel Hill. More than half a million tonsillectomies are performed each year on children in the U.S., making it the second most common surgery in this age group, just behind procedures to place tubes in the ears to relieve recurrent ear infections. Despite the fact that it is a mainstay of American medicine, experts have long disagreed about how useful or appropriate tonsillectomies may be. The new guidelines, published Monday by the American Academy of Otolaryngology - Head and Neck Surgery, are the first set of official recommendations on tonsillectomy published in the U.S. The guidelines aim to give doctors and parents more information about when tonsillectomy may be warranted and to help minimize the risks and pain of this procedure in young patients. “I thought they were very comprehensive,” says Drake, who reviewed the new recommendations but was not involved in drafting them. “This is an area where improvements and refinements can have a huge impact. This is medicine at its core.” New Criteria for Removing Tonsils The guidelines update a set of clinical indicators for tonsillectomies published in 2000 by the American Academy of Otolaryngology, which suggested that doctors could consider taking out the tonsils if a child had at least three cases of swollen and infected tonsils in a year. The new guideline, however, says that kids should have at least seven episodes of throat infection, such as tonsillitis or strep throat in a year, or at least five episodes each year for two years, or three episodes annually for three years, before they become candidates for surgery, and that those infections should be documented by a doctor, rather than just reported by parents. The idea, experts said, was to reserve surgery only for the most severely affected, because the surgery can rarely have serious complications including infections and serious bleeding. “Children who have fewer episodes really aren’t going to see a lot of benefit,” says Jack L. Paradise, MD, professor emeritus of pediatrics at the University of Pittsburgh School of Medicine. “There aren’t many kids, overall, who meet those stringent criteria,” Paradise says. What’s more, Paradise, and other experts stress, that even children who satisfy the guidelines shouldn’t get an automatic green light for surgery. “I’m not sure, if I had a child that met all the criteria, that I’d automatically subject the child to the consequences of that,” Paradise says, “Post-operatively, it’s a very painful procedure.” The tonsils are cone-shaped lumps of tissue embedded in the throat, and they are believed to play a role in how the body responds to infections, though experts aren’t exactly sure how. But in the early part of the 20th century, the tonsils were blamed as the “focus of infection” in the body, and doctors began taking them out as a way to promote good health. The operation became so common for example, that entire classrooms of youngsters would get their tonsils taken out at school. But by the 1970s, many experts were questioning how effective and appropriate it was to subject kids to a painful operation that could have rare but serious complications; all for what new research suggested were minimal improvements in the risk of sore throats. At the same time, however, doctors were starting to become more aware of the myriad problems tied to sleep disordered breathing in children, a spectrum of problems that can range from snoring to obstructive sleep apnea. And more tonsils began to be taken out as a way to open up the airway and improve sleep. Improvement in Care for Kids Having Surgery Several of the guidelines suggest ways doctors and parents can improve the care of children having tonsillectomies. One of the strongest recommendations is against the use of antibiotics just before or just after surgery. “They are commonly given, and there’s no evidence that antibiotics offer any benefit,” says study researcher Reginald F. Baugh, MD, professor and chief of otolaryngology at the University of Toledo Medical Center in Ohio. “You run the risk of allergic reactions and there are the harms of over-prescribing.” In drafting the statement that advises doctors to counsel parents about the importance of pain management in kids after surgery, Baugh says the panel that reviewed the evidence behind the guidelines was alarmed to learn that many parents don’t give medications to control pain after the procedure. “That was one thing we really learned, about the importance of telling parents about the need to give pain meds in these kids,” Baugh says.

Your Child

Another Study Finds No Vaccine –Autism Connection

2:00

A new study, using insurance records for nearly 96,000 U.S. children, found no link between the measles - mumps – rubella (MMR) vaccine and autism – even among children who are at an increased genetic risk.

Experts are hoping that this study, along with several other studies on the risks of autism and the MMR vaccine, will reassure parents that the vaccine is safe.

While the original 1998 study associating the vaccine with autism has been found fraudulent, many parents continue to worry that the vaccine could be a trigger for autism; particularly parents that already have a child with autism.

"Research has shown that parents of kids with autism spectrum disorders are more likely to delay vaccinating their younger children," said Dr. Bryan King, an autism researcher at the University of Washington, in Seattle.

"Basically, they wait until the developmental dust has settled, and it looks like their child will be unaffected (by autism)," said King, who wrote an editorial published with the study.

Health officials are concerned that children who do not receive the MMR vaccine are putting other children at risk for serious diseases. They point to the recent measles outbreaks as one example. So far this year, 162 people have been sickened across 16 states and Washington D.C. according to the U.S. Centers for Disease Control and Prevention (CDC).

Scientists are working hard to find out why there has been an increase in autism over the last decade.  It's known that genes make certain children more vulnerable to autism -- that's why kids with an affected older sibling are at higher-than-average risk. But environmental factors also have to play a role, experts believe.

Based on years of research, the MMR vaccine is not that trigger, according to health experts. "Every study that's looked at this, through every strategy they've used, has found no signal," King said.

According to King, it's natural for parents with a child who has autism to want to reduce their younger kids' risk.

"Everyone believes there have to be environmental factors contributing to the exponential rise we've seen in ASDs," he said. "But we don't understand what those factors are yet."

Researchers are finding clues, though. And more and more, they suspect that prenatal brain development is the critical period, King said.

The new findings are based on insurance records for nearly 96,000 U.S. children with an older brother or sister; 2 percent had an older sibling with an autism spectrum disorder.

Of the children with an affected sibling, 7 percent had an autism spectrum disorder themselves, compared to just under 1 percent of other kids. There was no evidence, though, that the MMR vaccination raised the risk of autism in either group of children, Jain said.

Among kids with an affected sibling, those who'd received one MMR dose by age 2 were actually one-quarter less likely to be diagnosed with an autism spectrum disorder, the study found. The odds were even lower among those who'd received two doses by age 5.

The study did not reveal any evidence that the MMR vaccine offered any protective influence over autism, only that it was not associated with an increase of risk for autism.

More studies are in the works to find the source of autism. Environmental factors are playing a key role in many of those studies as well as genetic links.

It’s understandable that parents would worry about vaccinations of any kind having a negative effect on their child, but more and more studies confirm that the MMR vaccine is one that parents can eliminate from their list of concerns.

This study was reported in the April 21 issue of the Journal of the American Medical Association.

Source: Amy Norton, http://consumer.healthday.com/cognitive-health-information-26/autism-news-51/another-study-finds-no-vaccine-autism-link-698635.html

Your Baby

Eating Fish During Pregnancy Benefits Baby’s Brain Development

2:00

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, http://www.reuters.com/article/us-health-pregnancy-fish-idUSKCN0UW1S4

 

 

 

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Count your blessings this Thanksgiving!

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