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Daily Dose

No Screen Time for a Week!

Kids are spending over 7 hours a day in front a screen: TV, watching video, playing games event texting. How much is too much?So, how much screen time does your child have?  You know what I mean, TV time, computer time, playing video games, using a cell phone (including texting). The list goes on and on!

The average American child spends 7 hours a day involved with some type of media, which is more than any other activity besides SLEEP! With that being said, this is National Turn Off Week!  My colleagues at the American Academy of Pediatrics are supporting an effort to encourage parents to implement a “screen free week” in their home. If the average child spends over 1000 hours a year involved in some type of media but only 900 hours a year in school it seems obvious that we are doing something wrong. The solution is to start limiting screen time beginning at the earliest ages. With so many parents believing that Baby Einstein videos will make their infant smarter (there is no proof), and parents who are teaching their children to use a computer or I-phone or I-pad by the age of two, early guidelines regarding time spend “on screen” are exceedingly important. The AAP endorses a “no TV for children under the age of two” rule and limiting TV/media time to 2 hours per day for children and teens.  Unfortunately, many parents may know that their children are home, but are not clear about what they are doing while at home, which often involves screen time in the “privacy” of their own rooms. I ask every patient and or parent about media time and if there is a TV or computer in the child’s room. I am continually amazed at how often the answer is yes, even for the elementary school set. Parents often view putting a TV in their child’s room as a “right of passage” despite the fact that there are really good studies to show that having a TV in a child’s room contributes to poor sleep habits which may impact children in many negative ways. I must say, there isn’t a teenager that I take care of that is “happy” that we are discussing media time, but just like other subjects that need to be addressed during a pediatric visit, this one may be more important than previously thought. For all of this interactive screen time may actually be becoming new “peer group” for a child, rather than having face to face time with their peers. So by turning off the “screens” and spending some time enjoying one another, a new normal could be started.  Families cooking together after the homework is finished, or going outside for a family walk or quick game, or reading together, or even playing board games, the list seems endless.  What a treat to get back 2, 3 or even 4 hours a day with your child.  Think about the  benefits that come from decreasing screen time, which include better academics, better sleep, less depression and anxiety and even an impact on obesity. I know it is challenging for all of us, but this is a “do-able” task for a week. While all of the screen are in the “OFF” mode, talk about new guidelines for when the screens go back on.  In this case the adage “less is more” seems appropriate. That's your daily dsoe for today.  We'll chat again tomorrow. Send your question or comment to  Dr. Sue!

Your Child

Kid’s Head Injury Linked to Long Term Attention Problems

1:45

Even mild brain injuries may cause children to have momentary gaps in attention long after an accident occurs, according to a new study.

The study of 6- to 13-year-olds found these attention lapses led to lower behavior and intelligence ratings by their parents and teachers.

"Parents, teachers and doctors should be aware that attention impairment after traumatic brain injury can manifest as very short lapses in focus, causing children to be slower," said study researcher Marsh Konigs, a doctoral candidate at VU University Amsterdam in the Netherlands.

This loss of focus was apparent even when brain scans showed no obvious damage, the researchers said.

The study’s results are being released as schools gear up for a new academic year combined with some sports programs that can put children at risk for head injuries.

Traumatic brain injury can occur from a blow to the head caused by a fall, traffic accident, and assault or sports injury.

Concussion is one type of traumatic brain injury. In 2009, more than 248,000 teens and children were treated in U.S. emergency rooms for sports- and recreation-related traumatic brain injuries or concussions, according to the U.S. Centers for Disease Control and Prevention.

Here’s how the study was conducted.  Researchers compared 113 children who had been hospitalized with a traumatic brain injury with 53 children who had a trauma injury not involving the head. The injuries, which ranged from mild to severe, occurred more than 18 months earlier on average.

The researchers tested mental functioning and evaluated questionnaires completed by parents and teachers at least two months after the injuries.

The head-injured group had slower processing speed, the researchers found. And their attention lapses were longer than those noted in the other children. But unlike other research, no differences were reported in other types of attention, such as executive attention -- the ability to resolve conflict between competing responses.

As is typical with most studies, the results do not prove a cause and effect relationship, but an association.

The take-home message from this study is that even mild head injury can lead to problems, 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. He was not involved with the research.

"This study provides further evidence of the importance of trying to minimize brain trauma, since even when there is no visible damage on CAT scans or MRIs, there can still be a significant adverse effect on attention span and behavior," Adesman said.

This research underscores the need to protect children from head injuries through proper supervision, consistent use of child car seats and seat belts, as well as headgear when bike riding and playing contact sports, he added.

The study was published in the journal Pediatrics.

More information on brain injury in children can be found at the Brain Injury Association of America’s website, http://www.biausa.org/brain-injury-children.htm.

Source: Kathleen Doheny,  http://consumer.healthday.com/cognitive-health-information-26/brain-health-news-80/head-injury-may-trigger-attention-issues-in-kids-701821.html

Your Child

Antibiotic Resistance Rising in Kids with Urinary Tract Infections

2:00

Urinary Tract Infections (UTI) affect about 3 percent of children in the United States each year and account for more than 1 million visits to a pediatrician.

The most common cause of a UTI is the bacterium E.coli, which normally lives in the large intestine and are present in a child’s stool. The bacterium enters the urethra and travels up the urinary tract causing an infection. Typical ways for an infection to occur is when a child’s bottom isn’t properly wiped or the bladder doesn’t completely empty.

Problems with the structure or function of the urinary tract commonly contribute to UTIs in infants and young children.

UTIs are usually treated with antibiotics but a new scientific review warns that many kids are failing to respond to antibiotic treatment.

The reason, according to the researchers, is drug resistance following years of over-prescribing and misusing antibiotics.

"Antimicrobial resistance is an internationally recognized threat to health," noted study author Ashley Bryce, a doctoral fellow at the Center for Academic Primary Care at the University of Bristol in the U.K.

The threat is of particular concern among the younger patients, the authors said, especially because UTIs are the most common form of pediatric bacterial infections.

Young children are more vulnerable to complications including kidney scarring and kidney failure, so they require prompt, appropriate treatment, added Bryce and co-author Ceire Costelloe. Costelloe is a fellow in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, also in the U.K.

"Bacterial infections resistant to antibiotics can limit the availability of effective treatment options," ultimately doubling a patient's risk of death, they noted.

The study team reviewed 58 prior investigations conducted in 26 countries that collectively looked at more than 77,000 E. coli samples.

Researchers found that in wealthier countries, such as the U.S., 53 percent of pediatric UTI cases were found to be resistant to amoxicillin, one of the most commonly prescribed primary care antibiotics. Other antibiotics such as trimethoprim and co-amoxiclav (Augmentin) were also found to be non-effective with a quarter of young patients resistant and 8 percent resistant respectively.

In poorer developing countries, resistance was even higher at 80 percent, 60 percent respectively and more than a quarter of the patients were resistant to ciprofloxacin (Cipro), and 17 percent to nitrofurantoin (Macrobid)).

The study team said they couldn’t give a definitive reason about cause and effect but said the problem in wealthier countries probably relates to primary care doctors' routine and excessive prescription of antibiotics to children.

In poorer nations, "one possible explanation is the availability of antibiotics over the counter," they said, making the medications too easy to access and abuse.

"If left unaddressed, antibiotic resistance could re-create a world in which invasive surgeries are impossible and people routinely die from simple bacterial infections," they added.

In an accompanying editorial, Grant Russell, head of the School of Primary Health Care at Monash University in Melbourne, Australia, said the only surprise was the extent of the resistance and how many first-line antibiotics were likely to be ineffective.

If current trends persist, he warned, it could lead to a serious situation in which relatively cheap and easy-to-administer oral antibiotics will no longer be of practical benefit to young UTI patients. The result would be a greater reliance on much more costly intravenous medications.

The problem of antibiotic resistance for bacterial infections has been on the minds of scientist for some time now.  Cases are increasing at an unprecedented rate causing alarm and a call for more public education and due diligence on the part of physicians that prescribes antibiotics.

Story source: Alan Mozes, http://www.webmd.com/children/news/20160316/antibiotic-resistance-common-in-kids-urinary-tract-infections

 

 

Your Child

Exercise Boosts Kids’ Grades!

2:00 to read

We all know that exercise is good for the heart, lungs, weight-control and now a new study suggests that it’s good for increasing academic performance as well.

The Dutch researchers reviewed several prior studies conducted in the United States, one from Canada and another out of South Africa. What they discovered was that all the studies showed that the more physically active students are, the better they do in the classroom.

"We found strong evidence of a significant positive relationship between physical activity and academic performance," the researchers, led by Amika Singh of the Vrije Universiteit University Medical Center at the EMGO Institute for Health and Care Research in Amsterdam, the Netherlands, said in a journal news release.

"The findings of one high-quality intervention study and one high-quality observational study suggest that being more physically active is positively related to improved academic performance in children," the authors noted.

A total of 14 studies were reviewed. They involved students between the ages of 6 and 18. Some studies were smaller, working with 50 students, while another study had as many as 12,000 students. 

Researchers noted that students who exercised had increased blood flow and oxygen to the brain. These school-age children did better in the schoolroom. The analysis suggests that exercise also increases the levels of hormones responsible for curtailing stress and boosting mood, while at the same time establishing new nerve cells and synapse flexibility.

In recent years, there has been increasing evidence that has shown that many functions of the brain are highly dynamic, or “plastic”, meaning that the brain is able to continually change in response to stimulus and experience. This flexibility is thought to be a key property in allowing the nervous system to support short-term and sustained changes in output, associated with learning and memory.

Other studies have shown that people with early dementia benefit from exercise. Again, the increased blood flow and oxygen to the brain helps improve memory and learning function.

So, getting the kids off the couch and onto the playground (no matter whether it’s a public playground or the backyard) can help children stay physically fit and mentally alert.

The Dutch researchers would like to see more high quality studies conducted in this area of investigation.

"Relatively few studies of high methodological quality have explored the relationship between physical activity and academic performance," they acknowledged. "More high-quality studies are needed on the dose-response relationship between physical activity and academic performance and on the explanatory mechanisms, using reliable and valid measurement instruments to assess this relationship accurately."

It’s a pretty safe bet though, that the more a family exercises together, the healthier everyone will be.

The findings are published in the January issue of the Archives of Pediatrics & Adolescent Medicine.

Sources: http://consumer.healthday.com/Article.asp?AID=660288 / http://www.sussex.ac.uk/aboutus/annualreview/2011/mindandbrain

Your Child

Promising New Peanut Allergy Patch

1:30

Peanut allergies can be life-threatening for some children, but a new “peanut patch” may be the solution their parents have been searching for.

The small skin patch – known as Viaskin® Peanut -is applied to the child’s skin and appears to offer safe and effective protection against this serious condition.

“This is exciting news for families who suffer with peanut allergies because Viaskin represents a new treatment option for patients and physicians,” study author Hugh A. Sampson, a doctor at Kravis Children’s Hospital at Mount Sinai, said in a statement.

Based on the principle of epicutaneous immunotherapy (EPIT), the patch delivers small doses of peanut proteins when placed on patients’ skin.

The team of researchers completed a double blind, placebo-controlled randomized Phase IIb trial in which 221 individuals with peanut allergies underwent the therapy for a year.

The patch exposed patients to a small dose of peanut protein, ranging from 50 to 250 micrograms, for the course of the study.

The 250 µg peanut patch shows the most promise for researchers. “After one year of therapy, half of the patients treated with the 250 micrograms patch tolerated at least 1 gram of peanut protein – about four peanuts —which is 10 times the dose that they tolerated in their entry oral peanut challenge,” Sampson explained.

Compliance was greater than 95% and less than 1% of the participants dropped out of the study due to adverse symptoms. In fact, there were no serious adverse reactions related to the patch treatment.

Overall, children treated with the larger patch experienced a robust increase (19 fold) in peanut-specific IgG4 levels, the antibody associated with protection following immunotherapy.

“EPIT appears safe, well tolerated and effective. That’s good news for families who suffer from food allergies,” Sampson said.

While the results are promising, researchers will continue to follow the participants for another year. It could be several more years before the patch become available for consumers, but there is hope on the horizon.

Source: http://www.aaaai.org/about-the-aaaai/newsroom/news-releases/peanut-patch.aspx

Justin Worland, http://time.com/3718529/peanut-patch-allergy/

Your Baby

Kid’s Exposure to Dogs May Help Prevent Asthma

1:30

It may sound like the opposite would be true, but a new study suggests that when children are exposed to dogs and other animals early on, they’re less likely to have asthma later in life.

Researchers looked at more than one million Swedish children. They found that those who grew up with dogs in the home were nearly 15 percent less likely to develop asthma than those not exposed to dogs.

This ties in with an earlier study that showed children who grow up on farms also have lower rates of asthma.

The study was led by author Tove Fall, assistant professor of epidemiology at Uppsala University in Sweden. In a university news release, she noted that "earlier studies have shown that growing up on a farm reduces a child's risk of asthma to about half. We wanted to see if this relationship also was true for children growing up with dogs in their homes."

Fall said, "Our results confirmed the farming effect and we also saw that children who grew up with dogs had about 15 percent less asthma than children without dogs. Because we had access to such a large and detailed data set, we could account for confounding factors such as asthma in parents, area of residence and socioeconomic status."

Study senior author Catarina Almqvist Malmros, a professor of clinical epidemiology at the Karolinska Institute in Sweden, stressed that the finding is only relates to children who have not yet developed asthma or allergies.

"We know that children with established allergy to cats or dogs should avoid them," she said in the news release.

What about other pets, such as cats, birds or hamsters?  The jury is still out on that one.

"In this study, early exposure to dogs and farm animals reduced asthma risk, and this may or may not include other types of pets that children keep," said Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City. "The takeaway is that early exposure may reduce the incidence of a later pathological process," he said.

Experts have begin to warn parents that children raised in too sterile an environment are more prone to developing allergies and reactions to common bacteria and pet dander.  A little dirt and dander may be just what the doctor orders now to help prevent allergies and asthma later.

The findings were recently published online in the journal JAMA Pediatrics.

Source: Robert Preidt, http://consumer.healthday.com/respiratory-and-allergy-information-2/asthma-news-47/dogs-in-the-home-may-lower-kids-odds-for-asthma-study-finds-704764.html

Your Baby

Homemade or Commercial Baby Food- Which is Best?

1:45

A new study from the U.K. looked at homemade baby food versus commercial baby food bought in grocery stores. They both come up winners in some categories and losers in others.

The researchers wanted to assess how well homemade and commercially available readymade meals designed for infants and young children met age specific national dietary recommendations.

Once thought to be the ideal baby food, homemade meals turned out to be higher in calories and fat and more time-consuming to prepare, but less expensive and higher in nutrients and variety. Commercial baby food came in more convenient, lower in calories, total fats and salt but was more expensive and lacked variety. Sugar content was about the same in both foods.

Each option had upsides and downsides. For example, home-cooked food had higher nutritional content, but 50% of homemade meals also exceed calorie recommendations, and 37% exceeded the recommendations for calories from fat, reported a research team led by Sharon Carstairs, a PhD student at the University of Aberdeen in Scotland.

Only 7% of the commercial baby food evaluated exceeded calorie recommendations, and less than 1% exceeded recommendations for calories from fat, Carstairs and colleagues reported in Archives of Disease in Childhood.

Researchers compared the store-bought meals with 408 recipes for home-cooked infant meals obtained from best-selling published cookbooks. The investigators entered the recipe ingredients into dietary analysis software to calculate the nutritional composition of the recipes per 100 grams.

A chief limitation of the study was that it only analyzed the recipes for homemade meals and did not take into account how these meals might be prepared in "real life."

"Parents may use cookbooks prescriptively or only as guidance, and thus the nutritional content of home-cooked recipes can vary greatly, and this can be augmented further by natural variations in the nutritional composition of raw ingredients," Carstairs and colleagues noted.

In addition, "the authors may have overestimated the values for salt within home-cooked recipes as it was often cited as optional; these results should thus be considered with caution."

The study reassures parents that it is okay to give homemade food to babies being weaned from breast milk or formula, Lauri Wright, PhD, of the University of South Florida College of Public Health and a spokesperson for the Academy of Nutrition and Dietetics, told MedPage Today.

"This is an important study, because in the United States parents think they have to do the commercial foods. Parents are afraid their child will miss out on nutrients if they don't give the specialized baby food."

The greater variety offered by homemade food may result in healthier taste preferences later in life, Wright added. "We used to think that taste preference developed at age 4 or 5, but we now know that taste preferences develop with the introduction of these first solid foods."

The bottom line from this study is that both types of baby food are acceptable; each comes with its own pros and cons. Just like with any other meal, how your homemade baby food is prepared is the key to whether it’s going to be healthy or not for baby. Understanding the guidelines for nourishing infant food and knowing the nutritional values of the foods you use, can help you prepare a wholesome meal for baby. Commercial baby foods also offer convenience and lower calories and fats. A mix of both will probably suit most families very well.

Story source: Medpage Today staff, http://www.medpagetoday.com/pediatrics/generalpediatrics/59228

 

 

Your Child

Concussions May Last Longer in Girls

2.00 to read

New research suggests that girls who suffer a concussion may have more severe symptoms that last longer compared to boys.

No one seems to know why there is a difference, but other studies have come to the same conclusion.

"There have been several studies suggesting there are differences between boys and girls as far as [concussion] symptom reporting and the duration of symptoms," said Dr. Shayne Fehr, a pediatric sports medicine specialist at Children's Hospital of Wisconsin.

In his new study, Fehr also found those differences. He tracked 549 patients, including 235 girls, who sought treatment at a pediatric concussion clinic.

Compared to the boys, the girls reported more severe symptoms and took nearly 22 more days to recover, said Fehr, also an assistant professor of pediatric orthopedics at the Medical College of Wisconsin.

In the new study, Fehr tracked patients from 10 to 18 years old. All were treated between early 2010 and mid-2012. Each patient reported on their symptoms, how severe they were and how long it took from the time of the injury until they were symptom-free.

Girls reported more severe symptoms and took an average of 56 days to be symptom-free. In comparison, the boys took 34 days. Overall, the time to recovery was 44 days when boys and girls were pooled.

The length of time it took for patients to fully recover from concussion is quite a bit longer than people usually think.

"Commonly you hear that seven to 10 days [for recovery] is average," Fehr said.

The patient’s who were part of this study went to concussion clinics, so their injuries may have been more acute.

Fehr did not find age to be linked with severity of symptoms. Most of the injuries -- 76 percent -- were sports-related, with football accounting for 22 percent of the concussions.

The top five reported symptoms were headache, trouble concentrating, sensitivity to light, sensitivity to sound and dizziness. Boys and girls, in general, reported the same types of symptoms, Fehr said, but the girls reported more severity and for a longer time period.

Fehr will present the findings at the American Medical Society for Sports Medicine this week. Studies presented at medical meetings are typically viewed as preliminary until published in a peer-reviewed journal.

Whether it’s a boy or a girl that suffers a concussion, it's important to be seen by a doctor and not return to play prematurely, which can be dangerous or even fatal, according to the American Academy of Pediatrics.

Anyone with a history of concussion is also at higher risk for another injury.

Source: Kathleen Doheny, http://www.webmd.com/brain/news/20140410/girls-suffer-worse-concussions-study-suggests

Your Teen

Early Puberty and Bone Health

1.50 to read

The normal rate of bone mass decline in adulthood is about 1 to 2 percent each year. This means that a 10 to 20 percent increase in bone density resulting from a naturally early puberty could provide an additional 10 to 20 years of protection against normal age-related decline in bone strength, according to the researchers.A new study suggest the earlier your child starts puberty, the lower the risk he or she will have osteoporosis later in life.

The research was based on 78 girls and 84 boys, who were studied from the time they began puberty until they reached sexual maturity. The investigators found that adult bone mineral density was influenced by age at puberty onset, with greater bone mass linked to early puberty and less bone mass associated with later puberty. However, bone strength did not seem to be affected by how long puberty lasted. "Puberty has a significant role in bone development," study leader Dr. Vicente Gilsanz, director of clinical imaging at the Saban Research Institute of Children's Hospital Los Angeles, said in a hospital news release. "During this time, bones lengthen and increase in density. At the end of puberty the epiphyseal plates close, terminating the ability of the bones to lengthen. When this occurs, the teenager has reached their maximum adult height and peak bone mass," Gilsanz explained. Reduced bone mineral density leads to osteoporosis, which affects 55 percent of Americans aged 50 and older. The normal rate of bone mass decline in adulthood is about 1 to 2 percent each year. This means that a 10 to 20 percent increase in bone density resulting from a naturally early puberty could provide an additional 10 to 20 years of protection against normal age-related decline in bone strength, according to the researchers. The study was published in the January issue of the Journal of Pediatrics. Pediatricians have long understood the role of pediatric bone development in osteoporosis prevention. The tween and teen years are critical for bone development because most bone mass accumulates during this time. In the years of peak skeletal growth, teenagers accumulate more than 25 percent of adult bone. By the time teens finish their growth spurts around age 17, 90 percent of their adult bone mass is established. Following the teen years, bones continue to increase in density until a person is about age 30. The need for calcium in the diet. Calcium is critical to building bone mass to support physical activity throughout life and to reduce the risk of bone fractures, especially those due to osteoporosis. The onset of osteoporosis later in life is influenced by two important factors: •   Peak bone mass attained in the first two to three decades of life •   The rate at which bone is lost in the later years Although the effects of low calcium consumption may not be visible in childhood, lack of adequate calcium intake puts young people at increased risk for osteoporosis later in life. Other foods, including dark green, leafy vegetables such as kale, are also healthy dietary sources of calcium. But, it takes 11 to 14 servings of kale to get the same amount of calcium in 3 or 4 8-ounce glasses of milk. In addition to calcium, milk provides other essential nutrients that are important for optimal bone health and development, including: •       Vitamins D, A, and B12 •       Potassium •       Magnesium •       Phosphorous •       Riboflavin •       Protein The role of physical activity in bone development. Weight-bearing physical activity helps to determine the strength, shape, and mass of bone. Activities such as running, dancing, and climbing stairs, as well as those that increase strength, such as weight lifting, can help bone development. For children and teenagers, some of the best weight-bearing activities include team sports, such as basketball, volleyball, soccer, and softball. Studies show that absence of physical activity results in a loss of bone mass, especially during long periods of immobilization or inactivity.

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