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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

 

 

Your Baby

Sing to Soothe Your Crying Baby

1:30

Have you ever reached the end of your patience trying to soothe a crying baby? Next time, switch to singing instead of talking. You may be surprised at the results.

Researchers at the University of Montreal in Canada, found that infants respond sooner and stop crying longer when listening to a song instead of speech.

The small study involved 30 healthy infants, aged between 6 and 9 months. The purpose of the research study was to investigate how the emotional self-control of the infants would be influenced when they are exposed to music or speech.   

The researchers maintained the objectivity of the study by not using any sounds that could have been recognized by the children.

For their study, researchers at the University of Montreal in Canada, played Turkish music and two types of speech -- ‘baby-talk' and regular adult-directed dialogue to the infants.

Researchers deliberately chose a language and music that would be unfamiliar to the babies.

Mothers were placed behind the children to avoid contact and the environment cleared of any other possible stimuli.

After playing both the music and regular speech to the children, researchers found that singing was twice as effective at calming distressed babies compared to exposure to regular dialogue: Babies remained calm for an average duration of nine minutes before breaking out in tears, while dialogue -- both the ‘baby-talk' and adult speech -- kept them calm for less than half that time.

The findings are significant, authors note, because Western mothers speak more to their babies, than sing.

"Our findings leave little doubt about the efficacy of singing nursery rhymes for maintaining infants' composure for extended periods," said study co-author Isabelle Peretz in a statement.

"These findings speak to the intrinsic importance of music, and of nursery rhymes in particular, which appeal to our desire for simplicity, and repetition."

Next time your baby is cranky, don’t be bashful; break out all the nursery rhymes you know and sing away. It may be the just the sound your baby wants to hear.

The study was published in 2015 in the journal Infancy.

Story source: http://www.ctvnews.ca/health/singing-more-effective-than-talking-to-soothe-babies-study-1.2631472

 

 

Your Child

1 in 10 Kids Have an Alcoholic Parent

2.00 to read

Since the passing of singing legend, Whitney Houston, the public has heard almost non-stop about her battle with serious drinking and drug problems. We’ve also learned that her 18-year-old daughter has had her own trouble with drugs and alcohol. They may be celebrities, but they share one thing in common with many American families - the long-term effects of alcohol abuse.

More than 1 in 10 U.S. children are living with an alcoholic parent and are at increased risk of developing a host of health problems of their own, according to a new government study released on Thursday.

Researchers at the Substance Abuse and Mental Health Services Administration (SAMHSA) analyzed national survey data from 2005 through 2010. They found that on average, 7.5 million children, under the age of 18, lived with a parent abusing alcohol during any given year. That’s about 10.5 percent of the under 18 population.

About 6.1 million of the children, lived in a 2-parent household where one or both of the adults abused alcohol.

Researchers said that of the 1.4 million children who lived in a single parent home where the adult had a drinking issue, the overwhelming majority was in female-head of households. The figure given was 1.1 million households.

"The enormity of this public health problem goes well beyond these tragic numbers as studies have shown that the children of parents with untreated alcohol disorders are at far greater risk for developing alcohol and other problems in life," SAMHSA representative Pamela Hyde said in a statement.

The study said that children of alcoholics were at a greater risk for mental health problems including anxiety and depression.

Another not surprising discovery was that these children were at higher risk for being abused or neglected by their parents. They were also more likely to have thinking or language difficulties and four times more likely to develop alcohol problems of their own.

While this study looks at how many children live with an alcoholic parent, the American Academy of Child & Adolescent Psychiatry (AACAP) reports that if you substitute relative for parent then the statistic changes to one in five adult Americans have lived with an alcoholic relative while growing up.  Again, the statistic is pretty staggering.

What can be done to help children of alcoholics? There are support groups and resources available, but understanding family members, friends, teachers, coaches and counselors can also help lead these children down a more positive path.  

Children and adolescents of alcoholic parents can benefit from educational programs and mutual-help groups such as programs for children of alcoholics, Al-Anon, and Alateen. Early professional help is also important in preventing more serious problems for the child, including reducing risk for future alcoholism.  Child and adolescent psychiatrists can diagnose and treat problems in children of alcoholics. They can also help the child to understand they are not responsible for the drinking problems of their parents and that the child can be helped even if the parent is in denial and refusing to seek help.

Some resources for families dealing with alcohol abuse are:

1. National Association for Children of Alcoholics- www.nacoa.net

2. Al-Anon – www.al-anon.alateen.org

3. Adult Children of Alcoholics – www.adultchildren.org

4. The American Academy of Child & Adolescent Psychiatry- www.aacap.org

Sources: http://www.reuters.com/article/2012/02/16/us-usa-drinking-study-idUSTRE81F0CB20120216  / http://www.aacap.org/

Your Child

Melatonin May Help Kids with Eczema Sleep Better

2:00

Eczema is a common skin disease that affects as many as 30 percent of all kids.  It’s an itchy red rash that often causes continuous scratching. Numerous children with eczema have trouble sleeping through the night. A new study suggests that over-the-counter melatonin may help them sleep longer and better.

These sleep problems can be difficult to treat in these children, said Dr. Yung-Sen Chang, an attending physician in pediatrics at Taipei City Hospital Renai Branch in Taiwan. Antihistamines can stop working after a few days, and tranquilizers have potentially serious side effects, Chang said.

But giving children melatonin, his study found, "is safe and effective for helping children with atopic dermatitis fall asleep faster."

The link between the skin condition and insufficient sleep "has an impact on people with eczema at all ages," said Dr. Lawrence Eichenfield, chief of pediatric and adolescent dermatology at the University of California, San Diego and Rady Children's Hospital.

According to Eichenfield, it's generally established that it’s the itching that keeps people with eczema from getting enough sleep. However, Chang said that may not be the case.

Chang and colleagues discovered that patients with eczema, that had difficulty sleeping, had low levels of nocturnal melatonin. That intrigued Chang and inspired the new study.

"Melatonin is a natural human hormone with minimal adverse effects," Chang said, "so it seemed like a good choice for children."

The study was small and involved 48 children, about 22 months to 18 years old, who had eczema. The children received treatment with either an inactive placebo or a 3-milligram daily dose of melatonin at bedtime for four weeks. Thirty-eight participants then took the alternate treatment (melatonin or placebo) for another four weeks.

When the children took melatonin, the severity of eczema dipped slightly, possibly because melatonin's anti-inflammatory effect improved the skin condition, Chang said.

Also, kids taking melatonin fell asleep about 21 minutes sooner than kids taking the placebo, the findings showed.

Total nightly sleep rose by 10 minutes on average (from 380 to 390 minutes, or 6.5 hours total) in the melatonin group, while it fell by 20 minutes among those who took a placebo, according to the report.

The participants did not report any side effects. Melatonin supplements are inexpensive in the U.S.- typically under 9 cents a pill from one major supplier.

Eichenfield, who wasn't involved in the research, said the study appears to be well-designed. Melatonin hasn't been studied much as a sleep treatment for kids, he cautioned.

While Eichenfield said melatonin may turn out to be helpful, he said there are a broad set of other tools available to treat eczema and minimize its effect on children. He suggested tackling the skin condition first to try to mitigate the sleep issues.

Chang recommended that parents talk to their child's doctor before starting melatonin. As for adults, melatonin may help them, too. But more studies are needed, Chang said.

The study was published in a November online edition of the journal JAMA Pediatrics.

Source: Randy Dotinga, http://www.webmd.com/children/news/20151124/melatonin-might-help-sleepless-kids-with-eczema-study-finds

 

Your Baby

New Guidelines To Help Prevent Peanut Allergies

1:45

Peanut allergy is one of the most common food allergies. Even trace amounts can cause a severe reaction in a child that is allergic to the legume. Parents may be able to reduce the chance that their children will develop peanut allergies by introducing the food early on, as young as four to six months of age, experts now say.

The results of several studies on the positive benefits of introducing peanuts into a child’s diet, early in their life, are encouraging new recommendations from allergy experts.

“Guidance regarding when to introduce peanut into the diet of an infant is changing, based on new research that shows that early introduction around 4-6 months of life, after a few other foods have been introduced into the infant’s diet, is associated with a significantly reduced risk of such infants developing peanut allergy,” said Dr. Matthew Greenhawt, a pediatrician and co-director of the Food Challenge and Research Unit at Children’s Hospital Colorado in Aurora, Colorado, who coauthored the update.

“This is an amazing opportunity to help potentially reduce the number of cases of peanut allergy, but this can only be done with the cooperation of parents and healthcare providers,” Greenhawt told Reuters Health.

Research used for the restructured recommendations comes from the Learning Early about Peanut Allergy (LEAP) study. In that trial, infants at high risk for peanut allergies who were exposed to peanuts early were less likely to develop an allergy by the time they reached five years of age. The findings from that study were published last year in The New England Journal of Medicine.

The guidelines offer three approaches to introducing peanuts to infants- depending on their risk of allergy.

-       Infants with severe eczema, egg allergy or both are at high risk for peanut allergy. They should be exposed to peanuts as early as four to six months to reduce the risk of allergy. Beforehand, however, these infants should undergo a skin prick test. If the test yields no welt or a small welt of up to 2mm, parents can introduce peanuts at home. But if the test yields a welt of 3mm or larger, peanuts should be introduced in the doctor’s office - or not at all if the welt is large and an allergist recommends avoidance.

-       Infants with mild to moderate eczema who have already started solid foods should be exposed to peanuts at six months of age.

-       Infants without eczema or any food allergy are at low risk, and parents can introduce peanuts in an age-appropriate form at any time starting at age six months.

Giving an infant a whole peanut is not recommended because they can choke on them. However, there are ways to prepare peanuts that can be introduced safely.

Another coauthor of the new guidelines, Dr. Amal Assa’ad, a pediatrician and director of the FARE Food Allergy Center of Excellence at the Cincinnati Children’s Hospital Medical Center in Ohio, told Reuters Health, “Several appropriate forms of peanut-containing foods are creamy peanut butter that can be made softer or more liquefied by adding warm water and let it cool, or serving corn puffs containing peanut. For older infants, peanut butter can be added to apple sauce or other fruit purees.”

Parents should consult with an allergist or their pediatrician before giving their infant peanuts in any form.

While the news about early peanut allergy intervention has been noted by various medical, media and social networks, reliable strategies for how to determine who should and should not get the therapy and when to start it, have not been available. These new guidelines help answer those questions.

The updated guidelines will be published online in January on the National Institute of Allergy and Infectious Diseases website; in the meantime, the site provides the current 2010 guidelines on peanut and other food allergies.

Story source: Rob Goodler, http://www.reuters.com/article/us-health-allergies-peanuts-idUSKBN1361VW

 

Your Baby

Babies Can Tell the Difference and Sameness of Objects

1:45

How old are we when we begin to learn to tell when objects are alike or different?  Scientists involved in a new study say that with a little training, babies as young as seven months can discern whether objects are similar or not.

Previous studies have shown that toddlers have this ability, but researchers at Northwestern University, wanted to see if children could actually determine the difference at an even earlier age.  The scientists were the first to discover that infants can actually make this remarkable determination – long before they have the language skills to express abstract ideas.

“This suggests that a skill key to human intelligence is present very early in human development, and that language skills are not necessary for learning abstract relations,” said study author, Alissa Ferry, a brain development researcher.

To accomplish this, the scientists started out to see if seven--month-old infants could comprehend sameness and difference between two objects by showing them either two Elmo dolls or an Elmo doll and a toy camel until their observation time ran out.

They then had the infants look longer at pairs that were either the “same” or “different,” including test pairs composed of new items. The team saw infants who had learned the “same” relation looked longer at test pairs showing the “different” relation and vice versa. The team said this indicates the infants had figured out the abstract relation and recognized when the relation changed.

“We found that infants are capable of learning these relations,” Ferry said. “Additionally, infants exhibit the same patterns of learning as older children and adults — relational learning benefits from seeing multiple examples of the relation and is impeded when attention is drawn to the individual objects composing the relation.”

The researchers also believe that because the infants could learn the difference and the sameness of objects before they could speak, that this is a separate skill that humans need and develop early in their existence.

“The infants in our study were able to form an abstract same or different relation after seeing only 6-9 examples,” said study author Dedre Gentner, a professor of psychology at Northwestern. “It appears that relational learning is something that humans, even very young humans, are much better at than other primates.”

Source: Brett Smith, http://www.redorbit.com/news/health/1113398144/infants-can-compare-and-contrast-objects-study-052715/

 

 

Your Teen

HPV Vaccine, Proving Effective in Teenage Girls

2:00

While the controversy over the HPV vaccine may continue in some circles, a new study says the vaccine is proving effective in teenage girls.

The human papillomavirus (HPV) vaccine was introduced 10 years ago and its use immediately became a hot topic. The vaccine is recommended for young girls and boys ages 11 and 12, to protect them from the sexually transmitted virus that can cause cervical as well as anal, penile, mouth and throat cancers. 

The study found that in teenage girls, the virus’s prevalence has been reduced by two-thirds.

Even for women in their early 20s, a group with lower vaccination rates, the most dangerous strains of HPV have still been reduced by more than a third.

“We’re seeing the impact of the vaccine as it marches down the line for age groups, and that’s incredibly exciting,” said Dr. Amy B. Middleman, the chief of adolescent medicine at the University of Oklahoma Health Sciences Center, who was not involved in the study. “A minority of females in this country have been immunized, but we’re seeing a public health impact that is quite expansive.”

HPV vaccinations rates, in young girls and boys, have slowly been increasing, since the vaccine was introduced, but 4 out of 10 adolescent girls and 6 out of 10 adolescent boys have not started the recommended HPV vaccine series, leaving them vulnerable to cancers caused by HPV infections.

That is partly because of the implicit association of the vaccine with adolescent sexual activity, rather than with its explicit purpose: cancer prevention. Only Virginia, Rhode Island and the District of Columbia require the HPV vaccine.

The latest research examined HPV immunization and infection rates through 2012, but just in girls. The recommendation to vaccinate boys became widespread only in 2011; they will be included in subsequent studies.

Using data from a survey by the Center for Disease Control and Prevention (CDC), the study examined the prevalence of the virus in women and girls of different age groups during the pre-vaccine years of 2003 through 2006. (The vaccine was recommended for girls later in 2006.) Researchers then looked at the prevalence in the same age groups between 2009 and 2012.

By those later years, the prevalence of the four strains of HPV covered by the vaccine had decreased by 64 percent in girls ages 14 to 19. Among women ages 20 to 24, the prevalence of those strains had declined 34 percent. The rates of HPV in women 25 and older had not fallen.

“The vaccine is more effective than we thought,” said Debbie Saslow, a public health expert in HPV vaccination and cervical cancer at the American Cancer Society. As vaccinated teenagers become sexually active, they are not spreading the virus, so “they also protect the people who haven’t been vaccinated,” she said.

Many doctors are pressing for primary care providers to strongly recommend the HPV vaccine in tandem with the other two that preteen children now typically receive.

Many health experts are hoping that the positive results from this study will encourage more pediatricians and primary care physicians to discuss getting the vaccine with parents of young children.

The study was published in the online journal Pediatrics.

Source: Jan Hofman, http://www.nytimes.com/2016/02/22/health/vaccine-has-sharply-reduced-hpv-in-teenage-girls-study-says.html?ref=health

Your Child

Are You Making Your Child More Anxious?

2.00 to read

When a child shows that he or she is anxious or in distress, a natural response is for a parent to want to remove whatever is causing the discomfort. However, according to a new study, it may not be the best reaction for your child in the long run.

Researchers call it the “protection trap.” Basically it means smothering children with too much attention or making the menace go away.

The research showed that certain parental coddling behaviors might actually boost anxiety in a child, although the study doesn't prove a cause-and-effect relationship.

"We found evidence that when parents try to help their anxious children they do a lot of things," said study co-author Armando Pina, an associate professor of child developmental psychology at Arizona State University. "Some of them are good, like promoting courage with warmth and kindness. Others are less helpful, like promoting avoidance by overprotecting, which many times leads to more anxiety."

Other experts have also weighed in on this topic.

"Left untreated, anxiety disorders in youth are associated with greater risk for other psychological problems such as depression and substance use problems," said Donna Pincus, director of research at the Child and Adolescent Fear and Anxiety Treatment Program at Boston University. Anxiety problems can also disrupt families and cause kids to perform worse in school, she added.

So what should a parent do or not do?

"When children are in distress or upset they need parental comfort, reassurance and extra love. This is good," said study lead author Lindsay Holly, a graduate student at Arizona State University. "Sometimes, however, parents end up providing excessive reassurance and doing things for the child, like making excuses for why a child who is anxious in social situations won't go to a birthday party or talking for the child by ordering at restaurants."

Here’s how the study was conducted.

Researchers examined the results of a survey of 70 kids aged 6 to 16 who were treated for anxiety and/or depression at a clinic. The kids were equally divided among boys and girls and among whites and Hispanic/Latinos.

The investigators found that some kids were more likely to have anxiety and depression symptoms if their parents reinforced or punished their anxiety through various approaches. Among the two ethnic groups, "the only difference was that Latino parents seemed to attend more frequently to their children's anxiety," Holly said.

Pina noted that previous research has indicated that a certain kind of therapy can help kids become less anxious and more resilient by teaching the importance of facing fears. One of the goals of the therapy is to teach parents how to promote courage in the kids through a combination of warmth and kindness, Pina said.

Some experts believe that by exposing children to anxious situations in a controlled, supportive environment, they can learn how to handle their anxiety better.

Holly suggests that parents encourage their children "to do brave things that are small and manageable." A child who's afraid of speaking in public, for instance, might be urged to answer a question about whether they want fries with their meal at a restaurant.

While every child is going to be anxious at one time or another, a more difficult situation is when children suffer from an anxiety disorder. That is a more serious problem where someone experiences fear, nervousness, and shyness so much so that they start to avoid places and activities.

According to the Anxiety and Depression Association of America, anxiety disorders affect one in eight children. Research shows that untreated children with anxiety disorders are at higher risk to perform poorly in school, miss out on important social experiences, and engage in substance abuse. Anxiety disorder often shows up alongside other disorders such as depression, eating disorders, and ADHD.

The good news is that with treatment and support, a child can learn how to successfully manage the symptoms and live a normal childhood.

The study conducted at Arizona State University, looked at typical child anxieties and how parent’s interactions either helped or prolonged the anxiousness.

The study was published recently in the journal Child Psychiatry and Human Development.

Sources: http://www.cbsnews.com/news/overprotective-parenting-could-worsen-kids-anxiety/

http://www.adaa.org/living-with-anxiety/children/childhood-anxiety-disorders

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