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Daily Dose

Teens & Headaches Go Together

I just read an interesting study about teenagers with headaches. About one to two percent of adolescents have chronic daily headaches, defined as greater than 15 headache days per month for greater than three months.

Once school begins, teens stress levels increase with each week of school, and with that come more complaints of chronic headaches. It is not unusual for me to see several teens a week who complain that they have headaches every day. Despite these persistent headaches, the majority of adolescents continue to participate in their school activities, sleep well once they fall asleep and spend their weekends doing whatever it is that teens all do. I see very few teens who look like they are in “severe” pain, although they state that their head is “killing” them while they chatter away about where it hurts, and how often it hurts etc. It is quite reassuring to watch their faces and expressions as they go into detail about their headaches. In these cases it is important to obtain a good history to rule out any underlying pathology, as well as to inquire about family history of migraines. In this study the authors followed adolescents ages 12 – 14 years who met criteria for chronic daily headaches. They followed the group after both one and two years, and then again after eight years. The results showed that after one year 40 percent of adolescents still complained of chronic headaches. After two years, only 25 percent reported headaches. After eight years, only 12 percent reported chronic headaches. Most participants reported substantial or some improvement in headache intensity and frequency during the eight-year follow-up. The most significant predictor for ongoing problems with headaches was onset of chronic headaches before the age of 13 years. For the most part 75 percent of adolescents with chronic daily headaches improved over the eight-year period, which is quite reassuring. This study just seemed to confirm that teens and headaches go together. If a good history and physical exam is performed and there seem to be no underlying problems that contribute to their headaches, it is best to discuss the natural history of chronic headaches. I think it is important to spend time with adolescents to explore ways to alleviate stress as a trigger for chronic daily headaches. Basic changes in lifestyle such as healthy eating, regular exercise, and a good night’s sleep will often help reduce headaches. Relaxation techniques and cognitive behavioral therapy may also be utilized. At least we know that the headaches reduce with time, maybe just a maturational process, like many things! That’s your daily dose, we’ll chat again tomorrow.

Your Baby

Gap Between Pregnancies Linked to Autism

2:00

Does it make a difference how long a woman waits between pregnancies in the health of her newborn?  According to a new large study, the closer the pregnancies, the higher the risk that her child will have autism or other neurodevelopmental disabilities.

"Based on the current best available evidence, it appears that the ideal inter-pregnancy interval -- the time elapsed between the birth of the immediate older sibling and the conception of the younger sibling -- is 2 to 5 years, in order to reduce the risk of autism," said study author Dr. Agustin Conde-Agudelo. He is a researcher at the World Health Organization Collaborating Center in Human Reproduction at the University of Valle in Cali, Colombia.

Researchers looked at existing studies involving more than 1.1 million children and also found that waiting too long between pregnancies (5 years or more) could raise the odds of autism.

The reasons for the link between short pregnancy spacing and autism are not known noted Conde-Agudelo. He said that scientists believe nutrition and other factors may play a role.

The study doesn’t prove that either long or short intervals between pregnancies actually causes autism, just that there seems to be an association between the two.

Conde-Agudelo and his team reviewed seven large studies reporting a link between short birth spacing and autism. The investigators found that children born to women with less than 12 months between pregnancies were nearly twice as likely to develop autism as children born to women with three years or longer between pregnancies.

Three of those studies also reported a significant link between long pregnancy spacing and autism, especially for two milder types, which were formerly called Asperger's syndrome and pervasive developmental disorder.

Meanwhile, the findings also suggested that shorter pregnancy spacing was associated with an increased risk of developmental delays and cerebral palsy, which can affect body movement, muscle coordination and balance.

Conde-Agudelo and other researchers conjectured that the mother’s depleted levels of folic acid between closely spaced pregnancies might play a role in the rise of autism risk.

The B vitamin folic acid is necessary for proper brain and spinal cord development in fetuses, and women are typically advised to take folic acid supplements during pregnancy.

As for longer pregnancy intervals also potentially linked to autism, Conde-Agudelo said it's been hypothesized that related factors such as infertility, unintended pregnancy and maternal inflammation levels may affect autism possibility.

Most neurodevelopmental disabilities, including autism, are thought to be caused by a complex mix of factors. These include genetics, environment, parental health and behaviors during pregnancy, and complications during birth, the researchers said in background notes.

The study was published in the April online edition of the journal Pediatrics, and will appear in the May print issue.

Story source: Maureen Salamon,  http://consumer.healthday.com/cognitive-health-information-26/autism-news-51/pregnancies-close-together-may-raise-autism-risk-study-says-709733.html

Your Child

Concussion’s Effects May Linger in Kids

2.00 to read

Concussions have been in the news a lot lately, particularly when they relate to children. Awareness about the dangers of concussions has changed how schools, coaches and parents watch for and treat this kind of injury. A new study released this week points out that some concussion side effects can last longer than thought.

Children who suffer even a mild concussion can have attention and memory problems a year after their injury.

The study results were published in the Archives of Pediatrics and Adolescent Medicine, and suggest that problems such as forgetfulness, dizziness,  and fatigue may linger for up to about 20 percent after an accident.

Forgetfulness, difficulty paying attention, headaches and fatigue were more common in study children who lost consciousness or who had other mild head trauma that caused brain abnormalities on imaging tests, compared with kids who didn't get knocked out or who had normal imaging test results.

Longer lasting symptoms were not determined since the study only followed children for a year after their injury. For that year though, children who had injury-related symptoms experienced "significant functional impairment in their daily lives."

"What parents want to know is if my kid is going to do OK. Most do OK, but we have to get better at predicting which kids are going to have problems," said study author Keith Owen Yeates, a Neuropsychologist at Ohio State University's Center for Biobehaviorial Health.

Children who have concussion symptoms may need temporary accommodations such as extra time taking school tests, or wearing sunglasses if bright light gives them headaches, Yeates said.

Most of the children in the study received their concussion from a sports related injury or fall, but about 20 percent had a mild brain trauma injury from a traffic accident or some other cause.

The study included 186 children, aged 8 to 15, with mild concussions and other mild brain injuries treated at two hospitals in Cleveland and Columbus, Ohio. The reports are based on parents' reports of symptoms up to 12 months after the injuries.

The brain injuries studied were considered mild because they involved no more than half an hour of unconsciousness; 60 percent of kids with concussions or other brain trauma had no loss of consciousness.

Overall, 20 percent who lost consciousness had lingering forgetfulness or other non-physical problems a year after their injury; while 20 percent who had abnormal brain scans had lingering headaches or other physical problems three months after being injured.

The study adds to research showing that mild traumatic brain injuries, including concussions "should not necessarily be treated as minor injuries," Dr. Frederick Rivara, Archives' editor, said in a journal editorial.

More information is needed to determine who is most at risk for lingering problems after these injuries, and to determine what type of treatment and activity restriction is needed, said Rivara, a pediatrician and University of Washington researcher.

The Centers for Disease Control and Prevention (CDC) defines a concussion as a type of traumatic brain injury caused by a bump, blow, or jolt to the head that can change the way the brain normally works. Concussions can also occur from a blow to the body that causes the head to move rapidly back and forth. Even a “ding,” “getting your bell rung,” or what seems to be mild bump or blow to the head can be serious.

According to the CDC, if your child has any symptoms of a concussion - which include different sleeping patterns, mood changes or problems with cognitive processes - you should bring them to a medical professional. If the child is having a headache that won't go away, weakness or decreased coordination, vomiting or nausea, slurred speech, will not nurse or eat and/or is crying and cannot be consoled, they need to be taken to a hospital immediately.

Source: http://www.cbsnews.com/8301-504763_162-57391791-10391704/kids-with-concu...

http://www.cdc.gov/concussion/sports/index.html

Your Child

Obesity Related Heart Disease Found in Children as Young as 8

2:00

All you have to do is look around, wherever children are gathered, to see that there are far too many kids that are overweight in this country.  And sadly, some of these children may already be developing heart disease according to a new study.

The study reports that obese children as young as 8 years of age, are beginning to show signs of heart abnormalities.

"It is both surprising and alarming to us that even the youngest obese children in our study who were 8 years old had evidence of heart disease," said study lead author Linyuan Jing, a postdoctoral fellow with Geisinger Health System in Danville, Pa.

"Ultimately, we hope that the effects we see in the hearts of these children are reversible," Jing added. "However, it is possible that there could be permanent damage."

Researchers conducted MRI scans of 40 children between 8 and 16 years old. Half of the participants were obese; the other half was of normal weight for their age and height.

They found that the obese children had an average of 27 percent more muscle mass in the left ventricle region their heart, and 12 percent thicker heart muscle overall. Both are considered indicators of heart disease, Jing said.

Among 40 percent of the obese children, scans showed thickened heart muscle had already translated into a reduced ability to pump blood. The children with this reduced heart capacity were considered to be at “high risk” for adult cardiac strain and heart disease.

"This should be further motivation for parents to help children lead a healthy lifestyle," Jing said.

Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, called the findings "alarming."

Some of the obese children in the study were struggling with health complications often associated with excess weight, including asthma, high blood pressure and depression, the researchers said. But none displayed customary warning signs of heart disease such as fatigue, dizziness or shortness of breath, Jing said.

The study did not include kids with diabetes or those that were too large to fit inside the MRI scanning machine. Jing noted that the study might actually underestimate how many children are suffering from heart related problems associated with obesity.

Jing said it’s up to parents to help their children maintain a healthy weight. They should buy healthy foods instead of cheap fast food and fruit juice, "which is high in sugar but low in fiber," she said.

She also recommended that parents limit TV, computer and video game time and encourage more physical outdoor activities.

Childhood obesity isn’t just an American problem; it’s a global problem as well.  The World Heart Federation says that one in 10 school-aged children worldwide are estimated to be overweight. However, in the USA, the number of overweight children has doubled and the number of overweight adolescents has tripled since 1980.

The researchers believe that schools can play a role in helping families understand the health problems associated with obesity.

“…Schools and communities need to do a better job at educating both the parents and children about the health risks of overweight and obesity," said Jing.

Fonarow agreed adding, "Substantially increased efforts are needed to prevent and treat childhood obesity."

The findings were presented at the annual meeting of the American Heart Association in Orlando, Fla.

Data and conclusions presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.

Source: Alan Mozes, http://consumer.healthday.com/cardiovascular-health-information-20/misc-stroke-related-heart-news-360/obese-kids-as-young-as-8-show-heart-disease-signs-705099.html

 

 

 

Your Teen

Acetaminophen, No Threat To Child's Liver

2.00 to read

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

Your Baby

Benefits of Waiting to Clamp the Umbilical Cord

2:00

Could waiting just three minutes before clamping the umbilical cord after childbirth make a difference in your child’s motor and social skills? According to a new Swedish study, children of mothers that delay cord clamping, reap the benefits later in life – especially for boys.

Delaying cord clamping is already known to benefit babies by increasing iron levels in their blood for the first few months of life, researchers write in the most recent edition of JAMA Pediatrics.

“There is quite a lot of brain development just after birth,” said lead author Dr. Ola Andersson of Uppsala University in Sweden. “Iron is needed for that process.”

For the study, researchers followed up on 263 Swedish children born at full term to healthy mothers about four years earlier.

As newborns, the children had been part of a larger study in which a total of 382 babies were randomly assigned to either early cord clamping (within 10 seconds of birth) or late cord clamping (at least three minutes after birth).

Four years later, the children were similarly intelligent regardless of when their cords had been clamped, but there were some notable differences.

“When you just meet a child, you wouldn’t see or notice any differences,” Andersson told Reuters Health. “But we could see the differences in fine motor function.”

The children were tested for IQ, motor skills and behavior. Parents also reported on their children’s communication, problem solving and social skills.

Results of the study showed that overall brain development and behavior scores were similar for both groups, and there was no significant difference in IQ scores.

However, more children in the delayed cord clamping group had a mature pencil grip on the fine motor skills test and better skills on some social aspects compared to those whose cords were clamped early.

Researchers found that boys benefitted much more than girls.

Iron deficiency is much more common among male infants than among females, Andersson said.

“Girls have higher iron stores when they are born,” he said.

Delaying cord clamping by three minutes allows an extra 3.5 ounces of blood to transfuse to the baby, which is equivalent to a half a gallon of blood for an adult, Andersson said.

“There’s a lot of iron in that volume,” he said. “Even three minutes can have quite a lot of effect on the iron in the blood in the body for a long time after birth.”

The new study provides evidence of benefit for full-term babies in a developed country where nutritional deficiency is extremely rare, Andersson said.

“When a baby transitions from inside the womb to outside the womb, if you think about what nature does, it is not to clamp the cord immediately,” said Dr. Heike Rabe of the Brighton and Sussex Medical School and University Hospitals in the UK.

Why do doctors traditionally clamp the cord quickly? About 60 years ago, doctors began clamping the cord almost immediately because it was thought that it would reduce the risk of hemorrhage for the mother. Doctors now know that is not the case.

Even though the scientific understanding behind cord clamping has changed, it’s still difficult for some doctors to change how they’ve always done things.  Today, parents can have more say in how their baby is born and whom they choose to deliver their child.

Parents-to-be should discuss their wishes with their OB/GYN or family doctor ahead of time and weigh the pros and cons of delaying cord clamping for their particular birthing process.

Source: Kathryn Doyle, http://www.reuters.com/article/2015/05/26/us-gynecology-pediatrics-cord-neurodevel-idUSKBN0OB2ET20150526

 

 

Your Teen

Are Energy Drinks Rotting Your Teen’s Teeth?

2:00 to read

A lot of parents know that too many high sugar sodas are not only hazardous to their child’s waistline and health, but they can also cause cavities. But what about the energy drinks teens are gulping down? A new study suggests those drinks could be stripping the enamel right off their teeth.   

In a study published in the May/June issue of General Dentistry, researchers have looked for the first time at the effects of energy drinks on teeth. It turns out there's often a lot of citric acid in the drinks.

To give drinks a long shelf life and to enhance flavors, preservatives are added. It’s the preservatives that are very good at stripping the enamel off of teeth.

Dentists are especially worried about teens. 30 to 50 percent are now drinking energy and sports drinks and losing enamel. Once it's gone, teeth are more prone to cavities and more likely to decay.

"We are well aware of the damage that sugar does in the mouth and in the whole body — the role it can play in obesity, diabetes, etc," says Poonam Jain, an associate professor in the School of Dental Medicine at Southern Illinois University, Edwardsville, and the lead author of the study. "But the average consumer is not very well aware that acid does all kinds of damage, too."

To measure just how energy and sports drinks affect teeth, the researchers looked at the fluoride levels, pH, and something called "titratable acidity" of 13 sports drinks and nine energy drinks, including Gatorade and Red Bull.

The researchers then measured how much enamel the drinks took off teeth, dousing sliced-up molars in a petri dish with the beverages for 15 minutes, followed by artificial saliva for two hours. This was repeated four times a day for five days.

The researchers found that teeth lost enamel with exposure to both kinds of drinks, but energy drinks took off a lot more enamel than sports drinks.

Drink labels list citric acid in the ingredients, but they don’t have to show the precise amount.

The American Beverage Association (ABA) was quick to respond to the study.  

"It is irresponsible to blame foods, beverages or any other single factor for enamel loss and tooth decay (dental caries or cavities)," the ABA said in a statement responding to Jain's paper. "Science tells us that individual susceptibility to both dental cavities and tooth erosion varies depending on a person's dental hygiene behavior, lifestyle, total diet and genetic make-up."

"This study was not conducted on humans and in no way mirrors reality," the ABA noted in its statement. "People do not keep any kind of liquid in their mouths for 15 minute intervals over five day periods. Thus, the findings of this paper simply cannot be applied to real life situations."

Jain is concerned about health effects beyond cavities. She says consuming a lot of citric acid can lead to loss of bone mass and kidney stones. "This has become a big concern because people are drinking more of these drinks and less milk," she says.

Dentist Dr. Jennifer Bone, spokesperson for Academy of General Dentistry, the organization that publishes the journal, said in the statement that teens and adults should curb their intake of these types of drinks. If they're going to drink one anyway, she recommends they chew sugar-free gum or rinse their mouth with water after drinking the beverage.

"Both tactics increase saliva flow, which naturally helps to return the acidity levels in the mouth to normal," Bone said.

Sources: http://www.cbsnews.com/sections/health/main204.shtml?tag=hdr;cnav

http://www.npr.org/blogs/health

Daily Dose

Treating Ear Infections

Plenty if ear infections going around, so what's the best treatment?It has been very busy in my office with plenty of ear infections going around.  Once you have taken your child to the pediatrician and they have indeed been diagnosed with an ear infection (otitis), what’s next?

Like many things in medicine there is not one right answer to that question and there continues to be a debate on the treatment of ear infections.  The many articles that have been published in past years have looked at the prevalence of certain bacteria in causing ear infections, the role of viruses as a cause of ear infections and even when and if to treat an ear infection. The articles did not seem to have a clear consensus.  You may have noticed that too if you have seen different doctors who have different opinions about otitis treatment. Now, two recent articles in the New England Journal of Medicine (Jan. 2011) once again looked at antibiotic use for the treatment of ear infections.  In two double blind, placebo controlled, randomized trials (the gold standard for studies) researchers defined otitis as the “acute onset and presence of middle-ear effusion (fluid), bulging tympanic membrane (ear drum), erythema (redness) and pain. The studies were done in Europe and the United States, and looked at whether children between 6 months and 35 months of age improved more quickly if they received an antibiotic rather than a placebo (no antibiotic). This debate had been ongoing, and both of these studies showed that the children who received antibiotics had symptom resolution more quickly than those who were given placebo.  The study also showed that those who received antibiotics were more likely to develop diarrhea. (bummer, hate those side effects!) Given these recent studies I think that the consensus would be that young children with documented ear infections should receive a course of antibiotics. That would typically mean children 2 and under. But, these studies did not look at the practice of what is called “watchful waiting” which has been advocated for older children. When a child over the age of two complains of ear pain, and is then examined and found to have an ear infection it may not always be necessary to prescribe an antibiotic. If the child is old enough to easily evaluate and does not appear ill it may be appropriate to be conservative about antibiotic use, and to provide pain relief with topical ear drops and oral pain relievers such as acetaminophen or ibuprofen. In many cases in an older child, the pain and infection will resolve over several days and an antibiotic will not be necessary. I often write a prescription for a parent to use if their child seems to become more uncomfortable, or the pain persists. In most cases these prescriptions have not been used. Doctors should take into account the history of previous ear infections, parental concerns as well as concerns about excessive use of antibiotics. “Watchful waiting” requires educating parents and having a discussion as to the pros and cons of antibiotic use. Each case may be a little different. Ear infections are still one of the most common reasons a child receives an antibiotic. These two articles now help clear up the debate about antibiotic use in younger children. “Watchful waiting” may still be appropriate for an older child with a simple ear infection. That’s your daily dose for today.  We’ll chat again tomorrow.

Your Toddler

Proof That Reading to Your Child is Good for Them

1:45

Not only do small children love being read to but a new study confirms that it is actually good for them.

Brain scans taken of 19 preschoolers whose parents regularly read to them showed heightened activity in important areas of the brain. Experts have long theorized that reading to young children on a consistent basis has a positive impact on their brain development; researchers say this study provides hard evidence that it does.

 The study’s leader Dr. John Hutton, of Cincinnati Children's Hospital Medical Center,

 and his team used functional MRI scans to measure real-time brain activity in 19 children, aged 3 to 5 years, as they listened to stories and to sounds other than speech.

Parents were interviewed about "cognitive stimulation" at home, including how often they read to their children. Based on their responses, the number ranged from two nights a week to every night.

Overall, Hutton's team found, the more often children had story time at home, the more brain activity they showed while listening to stories in the research lab.

The impact was largely seen in the area of the brain that is used to obtain meaning from words. There was "particularly robust" activity, the researchers said, in areas where mental images are formed from what is heard.

"When children listen to stories, they have to put it all together in their mind's eye," Hutton explained.

Even though children's books have pictures, he added, that's different from watching all the action play out on a TV or computer screen.

When a child is listening to a story being read to them, they are engaging a different part of the brain than when they are passively sitting in front of a screen with images.

The American Academy of Pediatrics (AAP) advises parents to read to their children every day, starting at birth. That pre-kindergarten time is a critical time for brain development, Hutton said. Other research has found that children with poor reading skills in first grade usually do not "catch up" with their peers.

Hutton believes that a traditional story time provides a critical "back-and-forth" between parents and children.

"It's not just a nice thing to do with your child," he said. "It's important to their cognitive, social and emotional development."

Reading to your child can help him or her build a lifelong relationship with the written word. That skill will help them be able to navigate more easily in school, later on in business and can bring hours of personal pleasure through the stories of gifted writers.

Source: Amy Norton, http://consumer.healthday.com/cognitive-health-information-26/brain-health-news-80/brain-scans-show-why-reading-to-kids-is-good-for-them-701897.html

 

 

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