Parents have some homework to do, according to new findings presented at the Pediatric American Society meeting in Honolulu, Hawaii, this weekend.

The research shows that 31% of U.S. parents know very little about the pace of a typical infant’s development, whether it’s when a child should start talking or begin potty training. The data is based on an analysis of the Early Childhood Longitudinal Study’s Birth Cohort, a nationally representative sample of more than 10,000 9-month-old babies and their primary caregivers. Parents were asked to answer 11 questions, where those who got four or fewer correct were considered to have low-level knowledge.

While it may not sound like a big deal, experts say that this lack of knowledge can negatively affect parents’ interactions with their babies.

We asked study author Dr. Heather Paradis, a fellow in pediatrics at the University of Rochester Medical Center, why so many parents don’t know what to expect after expecting and what they need to know about their babies’ development.

Why do so many parents lack knowledge about infant development?

I think that parents get parenting information from a variety of sources, from reading magazines and books … most importantly, parents look for information from their child’s doctors.

There’s a lot of information that’s out there about what to expect when people are pregnant, but I don’t know that there is quite as much information on what to expect about how your child grows and develops in the first years of life, and there’s a tremendous amount of change. This study was surprising in just how many parents don’t have knowledge of normal infant development.

Do you have a sense as to whether this is a new trend?

I think that a lot of emphasis in the past has been placed maybe on what we would call “high-risk” parents–those with a lower education, lower socioeconomic status. But one of the surprising things that this study showed is that it’s not only those parents we should be targeting, but it’s something we should expand to the general population of parents. Everyone could benefit.

What was one of the most surprising things the study revealed in terms of parents’ confusion?

The most surprising thing to me was not necessarily what knowledge they did or didn’t have, but how that knowledge translated into actual behavior, or observed interaction with the child. That connection is something lacking in previous studies. This study showed that parents who have higher knowledge of normal infant development were shown to have higher (quality) observed interactions with their children.

The other thing is that we looked at not only parent/child interaction but parents’ reports of frequency of what I would call enrichment activities, such as reading books with a child, singing songs. We know early enrichment activities with kids leads to higher IQs, earlier reading, better school preparation. The parents with the higher knowledge of normal infant development also had a significantly higher reported frequency of doing those enrichment activities with their kids.

What are the potential negatives?

Parents who have unrealistic expectations could misinterpret a child’s normal behavior and could respond inappropriately. An example would be like a mom who expects an 18-month-old child to sit still during an appointment. Eighteen-month-olds are normally curious. I would expect them to be wandering around the room. If parents are expecting a child to sit still on a chair for an entire appointment, they may take normal curiosity and interpret it as intentional defiance, rather than the normal curiosity it is. That could lead to inappropriate harsh discipline or the withdrawal of affection.

I think quite often parents maybe underestimate a child’s ability to pick up language skills. A lot of parents don’t think that it’s worthwhile to read a book to their infant, to their 2-month-old, and they definitely should be doing that, even if it’s to look at pictures and let the child hear the normal qualities of voice. They might not understand the words the parent is saying but they definitely understand what’s going on and the interaction going on between the two of them.

How should parents go about educating themselves?

Certainly, I think it’s an opportunity for pediatricians that, even during our brief office encounters with parents, we can potentially do something that can have a large impact on the way that parents and children interact. I do think that getting information from reputable sources, asking a child’s doctor for recommendations on books and Web sites to get high-quality information, is something parents could do.

Source: Forbes, NY
http://tinyurl.com/68hrk2

America’s increased focus on standardized test scores has meant more widespread use of drugs for ADHD—whether kids need ’em or not

Over the past few weeks, many thousands of Georgia elementary and middle school students sharpened their No. 2 pencils and waited for the teacher’s signal to turn over their answer sheets and hunker down to business on the Georgia Criterion Reference Test. Most did so without being under the influence of drugs, but some had been “juiced” for the test well in advance, perhaps even months or years in advance, through the use of drugs prescribed to treat attention deficit hyperactive disorder (ADHD).

Jennifer Fox, author of Your Child’s Strengths: Discover Them, Develop Them, Use Them, has seen the phenomenon herself. Fox, who is president of The Purnell School, a boarding school in New Jersey, describes a student she calls “Kate” (not her real name) who was extremely effervescent. She smiled a lot. She laughed a lot. She played a lot, even in class. Teachers complained that she wasn’t focused, so her parents had her put on a drug that was supposed to treat ADHD, and she lost that bubbly personality. It was as if the life “had been sucked out of her.”

“Kids are rushed to get diagnosed as learning-disabled so they can get extra time on tests and they can get put on drugs to perform better on tests,” says Fox, who is scheduled to sign her book at Wordsmiths in Decatur on Wednesday, April 30. “What we have in this country is a system that puts kids on drugs and gets them hooked on drugs for the rest of their lives.”

Though Fox acknowledges that there are children who definitely need medication, the problem, as she sees it, is an unhealthy focus on standardized test scores—a focus that parents often share with teachers, one that puts performance ahead of a child’s health and well-being.

“The schools are failing. The standardized tests are failing. And we are putting kids on drugs to try to overcome that,” she says. “That, to me, is like child abuse in a way.”

Fox points out that “Kate” had a strong suit—that bubbly personality that the drug erased. She says that she envisioned Kate someday working in a profession that required that kind of energy and vivaciousness. But since that strength was drugged out of her, who knows if Kate will ever make the most of the gift that she naturally had? Though Fox admits that there are kids who need medication to treat ADHD and other disorders, she adds, “I believe that it may be that these drugs are getting rid of the very thing that is best about these kids, something unique that the world needs.”

“Before You Take That Pill”

In his book Before You Take That Pill: Why The Drug Industry May Be Bad For Your Health, which hit bookstores in March, J. Douglas Bremner, a professor of psychiatry at the Emory University School of Medicine, explains that although its exact causes are not known, some scientists think that ADHD is related to alterations in the brain chemical dopamine, which modulates attention. Nonetheless, he views with skepticism the popularity of a plethora of stimulants used to treat ADHD, including Ritalin, Adderall and, a slow-release version of Ritalin, Concerta.

In his book, Bremner writes: “An entire generation of kids who cannot pay attention is being diagnosed more and more frequently (and sometimes inaccurately) with Attention Deficit Hyperactivity Disorder, or ADHD. It seems strange that it has been increasing so dramatically over the past few years. Certainly in the last generation many children with concentration problems were simply labeled unintelligent or ‘problem kids.’ However, with current competition for children to excel in school having reached such a fever pitch, it is no longer acceptable to let children fall behind. The elimination of recess, the lengthening of the school year, and the insistence that children remain rigidly fixed in their chairs without making a peep flies in the face of the realities of normal childhood.”

Bremner cites a three-fold increase in Ritalin prescriptions in the four years between 1991—which just happens to be the year that the U.S. Congress agreed that an ADHD diagnosis should qualify children for extra time on tests—and 1994. He goes on to point out that fully 10 percent of boys in America are prescribed some kind of stimulant for ADHD or other mental conditions.

On a recent weekday morning, Bremner, a soft-spoken man with a reserved demeanor, balances a laptop across his knees at a coffee shop, accepts an offered cheese cracker and explains his skepticism: “Do all of the kids who are taking Ritalin meet the requirements for ADHD? Probably not.”

There are reasons, not necessarily medical, that children might be prescribed a drug for ADHD, Bremner says. It may be that their parents want them to perform better in school, and those parents can pressure a doctor who is already pressured by pharmaceutical sales reps to write the prescription. It may also be the case that the child’s tendency to, well, be a child, is a problem.

“What we do know about these drugs and playfulness,” he says, “is that they tend to decrease playfulness.”

But how and why the drugs get prescribed isn’t the concern of the drug companies. The job of drug companies, he says, is not to make people well, but to sell drugs, and it’s a job that they do very, very well. Children, in particular, can provide a business boon, because once they’re on a drug, at what point is it OK to take them off? “Before You Take That Pill,” explores the risks of a wide range of drugs—not just those prescribed to children—and begins with the startling revelation that “Now, more than half of all Americans are taking a prescription drugs.”

All of the amphetamine-like stimulants used to treat ADHD, writes Bremner, act as appetite suppressants, and therefore may impede a child’s growth. They also “have been linked to approximately a doubling of heart-related deaths in children.” Such deaths are still rare, however. What he would like to see, Bremner says, is a little more skepticism on the part of Americans toward the extremely profitable drug companies.

Watching cartoons and drug commercials

Don’t count on the current crop of kids to be the ones to develop that skepticism. Rick McDevitt, executive director of the Georgia Advocacy for Children, says that drug use to solve problems has become an assumed part of American life, beginning when children are plopped in front of a television, where they view one pharmaceutical commercial after another. At school, he says, they are given to understand that if they do not do well on standardized tests, there might be something wrong with them that a drug can fix. Teachers tell parents their child isn’t focused and that they should seek help, and “help” turns out to be “take these pills.”

“The drugging of kids has become commonplace, the drug is a means of social control and the schools have become agents of that social control,” McDevitt says. “It’s about the test scores, it’s not about solving the problems at the source. The kids take the drugs, the test scores are better, and everyone says ‘They’re doing better.’ They’re not doing better. They are on drugs.”

Local child psychologist Sunaina Jain was listening to the radio recently when she happened upon a on a show on which people were talking about “our child-obsessed society.”

“I thought ‘What child-obsessed society?’ We don’t even like children in this society,” she says. “We do everything we can to make them become adults quickly.”

Jain, who has been in practice since before Ritalin hit the market in the late 1980s, says that the enormous use of drugs to treat ADHD is one more symptom of the need to make children become grown-ups. Although such drugs have helped many children, she says there is little doubt that they are over-prescribed. ADHD, she explains, affects about one boy in15 and girl in 25, but the number of prescriptions would seem to suggest that ADHD is epidemic in the United States.

“Part of the problem is parents who are looking for a way to improve their children’s test scores,” says Jain. “For these parents, these are ‘showcase’ children—their children’s success reflects on them. They want success, they want good grades, and if that can be obtained by popping a pill, that is what they do. There are also kids whose parents just don’t have time to pick them up from school and help them with their homework.”

The tendency to resort to drugs, she says, cuts through all economic classes. Like Fox, Bremner, and McDevitt, she points to a culture that makes it tough to be a kid. It’s a problem that affects the poor and the rich, though in different ways.

“If you have nanny-raised kids, you have the same problem that you have with poor, disadvantaged kids. With a nanny, they are not getting what they would from parents—they don’t learn how to connect with people,” Jain says. “Our strongest need is to connect with other human beings, and if you don’t learn how to do that, that’s a problem.”

The complaint she hears most from parents and teachers goes a long way in explaining what’s going on: “I don’t have time for this.”

The view of childhood as a time when competition makes or breaks one, as a screening process for winners and losers that needs to be gotten out of the way in time to join the adult world, is a view that distorts the children. Jain says the situation of children in America has steadily deteriorated since the 1980s. She believes that as a country, we have shifted away from seeing childhood as “practice” for adulthood and more as the game itself.

“But you know, you need practice to be good at the game,” she says. “A kid needs a coach, someone to say, ‘this is how you hold the bat.’ Then, after thousands of practices, one day they’re ready to go out into the world, to the game. A drug can’t tell them how to hold the bat.”

Source: Sunday Paper, GA
http://tinyurl.com/3o777x

Children with attention deficit hyperactivity disorder (ADHD) should get careful cardiac evaluation and monitoring – including an electrocardiogram (ECG) – before treatment with stimulant drugs, a new American Heart Association statement recommends.

The scientific statement on Cardiovascular Monitoring of Children and Adolescents with Heart Disease Receiving Stimulant Drugs is published online in Circulation: Journal of the American Heart Association.

In 1999, concerns over potential cardiovascular effects of psychotropic drugs, especially tricyclic antidepressants, but including stimulants, prompted an American Heart Association Scientific Statement: Cardiovascular Monitoring of Children and Adolescents Receiving Psychotropic Drugs. However, no specific cardiovascular monitoring was recommended for the use of stimulant medications. Warnings from the U. S. Food and Drug Administration (FDA) about stimulant medications and public concern for the safety of using them have prompted the current statement.

Studies have shown that stimulant medications like those used to treat ADHD can increase heart rate and blood pressure. These side effects are insignificant for most children with ADHD; however, they’re an important consideration for children who have a heart condition. Certain heart conditions increase the risk for sudden cardiac death (SCD), which occurs when the heart rhythm becomes erratic and doesn’t pump blood through the body.

Vetter also said doctors should evaluate children and adolescents already taking these medications if they were not evaluated when they started the treatment.

If heart problems are suspected after the evaluation, children should be referred to a pediatric cardiologist. Once stimulant treatment begins, children should have their heart health monitored periodically, with a blood pressure check within one to three months, then again at routine follow-ups every six to 12 months.

“Children can have undiagnosed heart conditions without showing symptoms,” Vetter said. “Furthermore, a child’s body changes constantly, with some conditions not appearing until adolescence.”

If the initial ECG was taken before age 12 years, it may be useful to do a repeat ECG after the child is over age 12 years, the statement says.

Widespread use of ECGs to detect heart abnormalities, including screenings for competitive athletes, is not routinely recommended by the American Heart Association. However, the writing group found using ECG screening in this specific population of children prescribed ADHD medication is medically indicated and reasonably priced. That said, however, lack of an ECG shouldn’t mean that kids who need ADHD treatment can’t get it.

“While we feel that an ECG is reasonable and helpful as a tool to identify children with cardiac conditions that can lead to SCD, if, in the view of their physician, a child requires immediate treatment with stimulant medications, this recommendation is not meant to keep them from getting that treatment,” said Vetter, who added that some children may not have access to a pediatric cardiologist who can evaluate an ECG or perform a cardiology consultation.

In 2003, an estimated 2.5 million children took medication for ADHD. Surveys indicate that ADHD affects an estimated 4 percent to 12 percent of all school-aged children in the United States, and it appears more common in children with heart conditions. Studies report that, depending on the specific cardiac condition, 33 percent to 42 percent of pediatric cardiac patients have ADHD, Vetter said. The number of undiagnosed children with heart conditions is unknown as routine heart screening is not performed, but Vetter said that a recent pilot study she presented at the American Heart Association’s 2007 Scientific Session indicated that up to 2 percent of healthy school aged children had potentially serious undiagnosed cardiac conditions identified by an ECG.

Data from the FDA showed that between 1999 and 2004, 19 children taking ADHD medications died suddenly and 26 children experienced cardiovascular events such as strokes, cardiac arrests and heart palpitations. Since February 2007, the FDA has required all manufacturers of drug products approved for ADHD treatment to develop Medication Guidelines to alert patients to possible cardiovascular risks.

Future studies are necessary to assess the true risk of SCD in association with stimulant drugs in children and adolescents with and without heart disease, Vetter said. However, studying SCD associated with drugs is difficult because the government’s reporting system is voluntary, which means local data on these types of deaths isn’t always reported nationally.

A registry of SCD events is necessary for further investigating this issue, the writing committee said. Such a registry would allow for a more accurate understanding of SCD, including the true incidence of it and the potential effectiveness of universal ECG testing and pre-participation screening questionnaires.

The statement writing committee said its recommendations are not intended to limit the appropriate use of stimulants in children with ADHD.

“Our intention is to provide the physician with some tools to help identify heart conditions in children with ADHD, and help them make decisions about the use of stimulant medications and the follow-up of children who take them,” Vetter said. “The goal is to allow treatment of ADHD, while attempting to lower the cardiac risk of these products in susceptible children.”

Source: EurekAlert, DC
http://www.eurekalert.org/pub_releases/2008-04/aha-cwa041808.php

A 13-year-old schoolgirl in southern Austria celebrated the start of her spring break with a bottle of schnapps.

She ended up in intensive care.

In other countries across Europe, adolescents are making similar headlines for drinking themselves into a stupor, often passing out in the process.

And they’re getting younger: A June 2006 European Union-commissioned report says nearly all 15-to 16-year-old European students have had alcohol at some point in their lives and, on average, now start when they’re just 12 1/2 years old.

The data comes from a 2003 survey by the European School Survey Project on Alcohol and Other Drugs.

More than one in six have “binged” - had five or more drinks on a single occasion - three or more times in the last month, said the report by the London-based Institute of Alcohol Studies. It excluded EU newcomers Bulgaria and Romania.

In contrast to the United States or Canada, where even adults are often asked to prove their age when buying beer and other alcoholic drinks, laws in Europe are more lax and the drinking age generally hovers around 16 or 18.

Supermarkets sell alcohol and, unlike in the U.S., bottles and cans are seldom stashed away in areas that are off-limits to underage customers. Carding is uncommon.

In Austria - where binge drinking is known as “Komatrinken,” or “coma drinking” - a new law prohibits the sale of alcohol to anyone under either 16 or 18, depending on the region, and requires cashiers and establishments to card customers if they have any doubt about their age. Failure to do so can result in fines of up to $5,610 and loss of a liquor licence.

“When it comes to coma drinking among young people, we’re dealing with a phenomenon that needs to be battled to the best of our abilities,” Economics Minister Martin Bartenstein said.

Authorities and experts alike acknowledge the issue isn’t going away.

The WHO estimates there are 76.3 million people with alcohol use disorders worldwide.

The experts warn that some barely pubescent juveniles are starting to reach for the bottle sooner.

“We’ve seen a whole series of new trends over the past five to 10 years,” said Michael Musalek, director of the Anton Proksch Institute, a renowned Austrian detox center that claims to be Europe’s largest.

“For one, the age of alcohol beginners keeps declining. Today, 11-, 12-, 13-year-olds are already drinking - some on a regular basis,” he said.

Hospital officials notice the same trend.

At Vienna’s General Hospital, up to three teens are admitted each weekend after drinking escapades escalate, often leaving them so intoxicated they become unconscious, pediatrician Zsolt Szepfalusi said. More cases are common during special events, such as the city’s annual Danube Island Fest in the summer, he said.

“The numbers aren’t really up - but we’re seeing a decrease in age,” Szepfalusi said. “Some of our patients are as young as 12.”

It’s not just a big-city problem. Robert Birnbacher, head of pediatrics at a public hospital in the southern Austrian town of Villach, said his clinic sees about one to two cases of young “coma drinkers” every weekend.

“The patients are getting younger and there are more girls among them,” he said.

Vladimir Poznyak, coordinator of the team working on the management of substance abuse in the World Health Organization’s Department of Mental Health and Substance Abuse, confirmed a general decline in age for initial contact with alcohol worldwide.

“It’s definitely happening and reflects general cultural changes,” Poznyak said.

The risks of starting to drink early include developing a dependence on alcohol and hampering brain development, he said.

In Germany, where beer is a big part of local culture, authorities are calling on adults to counsel their children to put off their first experiences with alcohol.

In October, the government’s “drug czar,” Sabine Baetzing, said every fourth teenager gets drunk off five or more alcoholic drinks at least once a month. The number of teenagers who ended up hospitalized with alcohol poisoning doubled from 9,500 in 2000 to 19,400 in 2005, she said.

But one expert, while welcoming action to fight alcohol abuse among Austria’s young, cautions against blowing the problem out of proportion.

Alfred Uhl, senior scientist at the Vienna-based Ludwig Boltzmann Institute for Addiction Research, said alcohol consumption in Austria peaked around 1970 and has declined ever since - despite the fact that prices have nose-dived. He warned that hospital statistics may be misleading because alcohol-related diagnoses were made less frequently in the past than they are now.

“Generally speaking, Europe’s youngsters are growing up faster than they used to and in countries such as Austria where alcohol is a part of the going out culture, it would be strange if they didn’t consume alcohol as well,” he said.

On the streets of the Austrian capital, teenagers dispute they drink heavily - but acknowledge alcohol has a presence in their lives.

“I started when I was 15 and like beer and tequila,” said 16-year-old Patrick Settinger, smoking a cigarette on his way home from school.

Source: The Canadian Press, Austria
http://canadianpress.google.com/article/ALeqM5g3fB9g7BnwevWxz-erjPnU3VdYGQ

Why people continue to blame vaccines, despite evidence to the contrary.

As the brother of an autistic person and a brain scientist, I have been hoping that the increased focus on autism in the news would lead to a greater public understanding of this disorder. Instead, I am angry that this coverage is spreading dangerous myths.

My sister, Karen, is autistic. In the 1970s, my parents wondered why she behaved so differently. At the time, a prevalent idea was that an emotionally distant mother could somehow prevent a child from understanding emotions or relating normally to others. Our parents had a simpler idea, that they might have hurt Karen’s head during a bath.

Both these ideas are wrong. Autism is a neurological disorder, and its signs appear by the age of 1 or even earlier. It is highly inheritable. In identical twins where one is autistic, the chance that both are autistic is greater than 50-50. Even non-identical twins and siblings are at increased risk. In short, I dodged a genetic bullet. Now I worry about my daughter.

A link that isn’t there

Recently, celebrities such as Jenny McCarthy and other activists have taken to the airwaves to repeat the myth that autism is linked to vaccination. Although peer-reviewed scientific evidence overwhelmingly opposes their views, they have attracted attention. In a recent discussion on Larry King Live, three pediatricians invited to make the case for science were no match for McCarthy’s star power. Situations like this could mistakenly persuade parents to leave their children unvaccinated and vulnerable to contagious diseases.

Speculation about a vaccine-autism link began with a 1998 uncontrolled study of a few autistic children. But the conclusions were later retracted. Subsequent speculation focused on the compound thimerosal. But removing it from all routine childhood vaccines in the USA, Denmark, Sweden and Canada has not decreased autism rates.

What are McCarthy’s credentials? She is an actress and comedienne — with an autistic son. Her career took on new life after she wrote a best-selling pregnancy guide. Like all parents of autistic children, she wrestled with the question of what caused his disorder. She recalled that her son was vaccinated about the time his symptoms first appeared. Aha! That’s it. Here is an example of her reasoning: “I believe that parents’ anecdotal information is science-based information.”

How we’re wired

Although her concept of evidence is flawed, I don’t blame her. The error highlights how our brains are wired to think. Like the authors of the 1998 study, she concluded that two events happening around the same time must be linked. They used the principle that coincidence implies a causal link. But there was no coincidence for her son: He was born in 2002, after thimerosal was removed from vaccines.

The problem is compounded by “source amnesia,” in which people are prone to remember a statement without recalling where they heard it or whether the source was reliable. Presidential candidate John McCain might have fallen prey to source amnesia when he repeated the vaccine-autism myth last month. Recollection is more likely when the “fact” fits previously held views; parents might already dislike vaccinations based on their kids’ reaction to shots. But when it comes to a complex issue such as autism, such errors of reasoning hinder us from distinguishing real causes from coincidences.

Out of sight of the cameras, increased research funding is spurring efforts to find autism’s causes. Scientists are vitally interested in possible environmental influences. But the vaccine story is a dry well. Working on it further wastes valuable time and resources. It’s time to dig elsewhere.

As I watch my beautiful 10-month-old daughter grow, I wish that preventing autism were as simple as withholding a few injections. But along with my wife, a physician, I understand the vital importance of vaccination, not only for maintaining our baby’s health but also protecting our community from infectious diseases. Our daughter’s next shots are in two months.

Sam Wang is an associate professor of molecular biology and neuroscience at Princeton University. He is a co-author of Welcome to Your Brain: Why You Lose Your Car Keys But Never Forget How to Drive and Other Puzzles of Everyday Life.

Source: USA Today
http://blogs.usatoday.com/oped/2008/04/autism-myth-liv.html

· Anti-psychotics may cause long-term harm, say critics
· Youngsters under 6 being given unlicensed drugs

New evidence has shown children’s lives are being put at risk by a surge in the use of controversial tranquillising drugs which are being prescribed to control their behaviour, the Guardian has learned.

The anti-psychotic drugs are being given to youngsters under the age of six even though the drugs have no licence for use in children except in certain schizophrenia cases, the report says.

The number of children on the drugs has doubled since the early 1990s as the UK begins to follow a trend started in the US, but critics say they are a “chemical cosh” that could cause premature death.

The first comprehensive analysis, carried out by Ian Wong, professor of paediatric medicines research at the London School of Pharmacy, suggests the number of children on the drugs has surged sharply.

His analysis, to be published next month in the US journal Pediatrics, shows that between 1992 and 2005, 3,000 UK children were given anti-psychotics.

Although the drugs are not licensed for children, doctors can prescribe them on their own responsibility.

The increase follows a huge rise in the use of the drugs in children in the US. Yet nobody knows how the drugs affect a growing child’s body or what may happen in the long term. The increase has come at a time when former psychiatric best-sellers Prozac and its class of anti-depressants have gone out of patent. Wong says children on anti-psychotic medication are more likely to die earlier - something which may not be caused by the drug but which gives cause for concern. “The mortality rate is much higher. It could be some underlying problem of the brain. It doesn’t show the drug is causing any deaths, but there is this inequality.”

Some of the children of whose deaths he is aware had underlying incurable conditions such as Aids, so it is hard to establish whether the drugs played any part.

David Healy, professor of psychological medicine at Cardiff University, says the drugs may cause heart, circulation and breathing problems. “There is a real question over whether the drugs can kill for a number of reasons. One is that all anti-psychotics act on [the brain chemical] dopamine.” He said dopamine was known to have a role in cardiovascular regulation. A number of children in the US, given stimulants - which also act on the dopamine system - after being diagnosed with ADHD (attention deficit hyperactivity disorder), have suddenly died, said Healy. He was asked by lawyers in the US to give an opinion on a child who was diagnosed when she was a baby first with ADHD, then depression and finally bipolar disorder (manic depression). “Having spent 75% of her life on one of these drugs, she dropped dead at the age of two,” he said.

The drugs have potentially serious and harmful side-effects which need to be balanced against any benefit for the child or its parents. These include substantial weight gain and tardive dyskinesia (uncontrollable tongue and facial movements).

The drug watchdog, the Medicines and Healthcare products Regulatory Authority, is concerned about the use of such drugs without evidence to prove they are safe in children, but unless the manufacturers conduct trials, its hands are tied.

Source: Guardian, UK
http://www.guardian.co.uk/society/2008/apr/07/mentalhealth.drugs

It remains one of the greatest mysteries of medicine. Although autism will be diagnosed in more than 25,000 U.S. children this year, more than new pediatric cases of AIDS, diabetes and cancer combined, scientists and doctors still know very little about the neurological disorder.

Unlike childhood diabetes or pediatric leukemia, there is no blood test, no scan, no image that can detect autism. Diagnosis relies totally on behavioral observation and screening. And that’s not easy.

According to the National Institute of Neurological Disorders and Stroke, three distinctive behaviors characterize autism: lack of social interaction, problems with verbal and nonverbal communication, and repetitive behaviors or narrow, obsessive interests. But children with autism display these symptoms in many different ways, some as mild as avoiding eye contact, while others are totally immersed in a world of their own.

Dr. Gary Goldstein, president of Kennedy Krieger Institute, one of the leading U.S. facilities for autism research and treatment, says although doctors know more about autism than ever, plenty of questions remain unanswered. Over the past few years, it has become clear that genetics play a big role in the development of autism. But researchers believe something — a trigger — sets off autism in a child.

“It’s a combination of being genetically vulnerable, and then having some kind of social or toxic exposure that tips you over,” Goldstein says. If scientists find that trigger, they could find the missing piece of the autism puzzle.

It’s that missing puzzle piece that frustrates families with autistic children. When the Gaston triplets of Ellicott City, Maryland, were born seven years ago, their parents, Lynn and Randy, were thrilled. For years, they had been trying to have children. After in vitro fertilization, Lynn gave birth to identical twins, Hunter and Nicholas, and a fraternal brother named Zachary. Though they were born prematurely, they grew to be healthy, happy babies. Then something changed.

At around 18 months, the boys began to display unusual behaviors. Zach became compulsive, lined up cereal boxes and toys; he wouldn’t socialize and kept to himself. Hunter would roam the house at night and scream at the top of his lungs. Nick just stopped talking.

Lynn asked her pediatrician about it. Her sons’ doctor said she was overreacting and they should wait and see. But Lynn and Randy were sure there was something wrong with their children. It was frustrating for Lynn, who watched her children change every day before her eyes. “It was almost as if somebody turned the switch off. It was like the first 18 months of their lives didn’t happen.”

As months passed, the Gastons became frustrated as doctor after doctor told them to wait. That was unfortunate, because doctors now know that the sooner autism is diagnosed, the better chance the child has for getting successful treatment.

“Early intervention is key, because brain development starts before birth,” says Dr. Pat Levitt, director of the Vanderbilt Kennedy Center for Research on Human Development in Nashville, Tennessee.

“During the ages of 0 to 5 years, there is a tremendous amount of change that occurs in the brain and brain chemistry.”

In October, the American Academy of Pediatrics set up new guidelines to help pediatricians recognize the early signs of autism, in order to diagnose the disorder and get children into treatment as soon as possible.

Unfortunately, that didn’t happen for the Gastons. Their boys were 4 years old before doctors at Kennedy Krieger confirmed the family’s fears. All three sons had some variation of autism.

The Gastons had never heard of autism before their sons were born. Now they were raising three autistic children. That was tough enough, but even after the diagnosis, it was hard to find any information on the condition. That’s because until recently, very little information on autistic children has been widely available. The Centers for Disease Control and Prevention have been collecting data only since 2001, the year the Gaston triplets were born.

Lynn expressed her frustration: “It’s not like you can look up autism in the phone book. I couldn’t go to the Yellow Pages and find a doctor, and didn’t even know what doctor to go see. I thought my pediatrician was going to handle all this.”

The Gastons keep asking themselves, “Where is the trigger?” They’ve each looked into their family history and found no autism.

Some parents believe that thimerosal, a preservative found in childhood vaccines that virtually every child gets, causes autism, because many children were diagnosed after they were vaccinated. But most medical experts increasingly doubt that theory, because even though the chemical has been removed from virtually all vaccines, the number of cases of autism is rising.

“You remove thimerosal from all but the flu vaccine, which isn’t given to children under 6 months of age, and the incidence of autism only increases. So you just have piece of evidence after piece of evidence after piece of evidence that really disproves this notion,” said Dr. Paul Offit, chief of the Infectious Diseases Division at Children’s Hospital of Philadelphia, Pennsylvania.

Although the Gastons don’t express their opinions on vaccines, Randy makes a point: “There’s something that’s affecting these children at that age, and it’s unfortunate that families are left to their own devices to find out what is going on.”

For now the Gastons remain dedicated to getting their sons the best care possible, which can be expensive. They sold their house in order to pay bills for therapy and doctors that total in the hundreds of thousand of dollars.

They are also involved in autism awareness groups and try to help other parents of autistic children understand what their children are going through. Just recently they shot a public service announcement to promote a new project developed by the Kennedy Krieger Institute, called IAN, or interactive autism network, an online project that can help autism researchers link with families of autistic children as well as with other scientists. The hope is that IAN will alert families to local and national autism research projects they can participate in.

But minus the projects and the doctors and the therapists, the Gastons, like many families with autistic children, believe it all comes down to the attention they give their children that makes the real difference.

To say it’s been difficult for the Gastons is an understatement. But above all, they love each other and work to give their children as much happiness as possible.

As Randy Gaston says while Zach turns to give him a hug and a smile, “The one thing he has to know for the rest of his life is that I did everything for him. That’s what it comes down to. I love him.”

Source: CNN
http://www.cnn.com/2008/HEALTH/conditions/03/31/autism.main/?iref=mpstoryview

Undiagnosed eye problems in babies and young children can affect early learning as well as physical and emotional development.

That’s why experts, including the American Optometric Association, recommend that children receive their first eye screening at 6 months and their first formal eye exam at the age of 3-1/2.

“They don’t need to verbalize or know the alphabet,” said Merrimack optometrist Kevin Chauvette, who specializes in children’s vision therapy, a subspecialty of optometry.

Chauvette, who owns and operates Merrimack Vision Care, said a trained practitioner can identify nearsightedness, farsightedness and astigmatism in an infant or young child, information that can be used to treat and prevent future problems.

“We’re trying to get the word out about the six-month screening,” Chauvette said. “A lot of parents just don’t know, and they depend on the school or the pediatrician to tell them what to do.”

Chauvette isn’t faulting anyone for the gap.

Screening recommendations for children are relatively new, he said, having been established about a decade ago.

Like other preventive health-care measures, he added, vision screening has been slow to catch on.

“The problem with vision is a lot of things can go wrong with the eyes that don’t cause pain,” the optometrist said. “If they don’t have pain or blurriness, people assume everything is OK.”

Nothing could be further from the truth.

For example, adults who have glaucoma, a disease that causes blindness, must undergo eye-pressure testing to confirm the condition. Otherwise, they will have no idea they are losing peripheral vision a little at a time.

By contrast, eye screening for children can identify eye problems that, left untreated, can lead to amblyopia or lazy eye, learning disabilities, behavior problems and other consequences, Chauvette said.

He said children who rub their eyes excessively, skip over short words, lose their place or cover one eye when reading may have vision problems. The same goes for the child whose handwriting is sloppy and disorganized.

During a baseline exam, Chauvette said he looks for symptoms such as a crossed eye or an eye that drifts outward, conditions that can be treated and corrected using a patch, eyeglasses or vision therapy.

“Children’s eyes change rapidly, and studies show that 80 percent of what is learned in the classroom is through the sense of vision,” he said, explaining why experts recommend annual eye exams for children after they start school.

Children’s eye exams are different from those given to adults.

“We look for factors that lead to lazy eye, the ability to learn at school,” Chauvette said, linking vision to both academic and social success. “Of kids having difficulties, a dramatically high percentage has underlying eye problems.”

He said experts believe that an increasingly sedentary lifestyle is to blame.

“Children are not outside playing. They’re looking at a computer, a flat world. They have more visual problems because they’re not interacting with a world in three dimensions, which is a necessary part of vision development,” Chauvette said.

In treatment, children are asked to accomplish complex tasks that require peripheral and central vision, as well as balance and motor skills. For example, a child might be asked to balance on a rail while tossing a ball.

“There’s almost nowhere in the brain where, if you make an incision, it doesn’t affect some part of vision,” Chauvette said, adding that vision influences balance, posture, memory and emotion.

Furthermore, a child identified with a learning disability has a 50-50 chance of having an undiagnosed vision problem, he added.

“If you intervene early, it’s fixable, treatable. It can be reversed,” Chauvette said of conditions that left untreated, can lead to failure in school and a constellation of social and personal problems.

Only about a third of all children have had an eye examination or vision screening prior to entering school, according to the American Optometric Association.

Nashua optometrist Ann Irwin, for example, said she has referred children for vision therapy and is pleased that state officials are talking about requiring an annual eye exam for all children before they begin school, similar to mandates for vaccinations and medical and dental exams.

Whether a child has vision problems, or is suspected of having them, Irwin said, she reminds parents to protect their child’s eyes.

“Children need sports goggles and sunglasses,” she said.

Source: Nashua Telegraph, NH
http://tinyurl.com/2adtyo

Hong Kong shut all primary schools and kindergartens, halting classes for more than half a million students, after four children with flu-like symptoms died.

“We have been working closely with the Department of Health and the secondary schools the last few days to know more about this spread,” said Anna Chan, an officer with the Education Bureau.” The young get contaminated more easily.”

Hong Kong announced the closures late yesterday, five years after severe acute respiratory syndrome killed 299 people and crippled the city’s economy. The government closely monitors influenza outbreaks, with the airport screening all incoming passengers for signs of fever.

“At this time of the year, it’s a viral soup everywhere,” said Peter Cordingley, the Manila-based spokesman for the World Health Organization’s Western Pacific region. “There is nothing exceptional in what is happening in Hong Kong at the moment.”

Two of the children who died tested positive for influenza A, the Health Department said. It declined to cite influenza as the cause of the deaths. Another two children died after suffering flu-like symptoms, the department said, adding that tests haven’t yet confirmed the presence of influenza A.

China’s government will cooperate with its “Hong Kong counterparts to control this flu incident so it does not spread,” Li Changjiang, head of the General Administration of Quality Supervision, Inspection and Quarantine, told reporters at a press conference in Beijing today. He didn’t say what action China would take.

“Little Drastic”

Closing schools “might be a little drastic, but it’s a reassurance to the community,” Hong Kong Secretary for Food and Health York Chow told reporters today.

The influenza viruses circulating in Hong Kong this year are predominantly type B and a variant of the type A (H3N2) strain that caused epidemics in Australia last year, including the deaths of three children, said John Nicholls, associate professor of pathology at the University of Hong Kong.

In Hong Kong, “there is a large number of kids being infected,” he said. Actual deaths from the disease are still very low, he said in an interview yesterday.

A 7-year-old boy died at the city’s Tuen Mun Hospital and the school closed amid the flu outbreak, state broadcaster Radio Television Hong Kong reported. A 3-year-old and 27-month-old have also died. No common factors between the deaths have been identified at this stage, according to the government.

“High Anxiety”

“If you look back to SARS, you can understand why there is a high level of anxiety in Hong Kong,” WHO’s Cordingley said. “Hong Kong is a very jam-packed-tight type city and it’s the perfect place for transmission lines to thrive.”

The deaths will be investigated to see whether the virus is mutating, Yuen Kwok-yung, a University of Hong Kong professor in microbiology, said at a press conference yesterday.

The Hospital Authority said it has earmarked HK$20 million ($2.6 million) to implement measures up to the end of April to cope with a surge in demand for public hospital services.

Flu outbreaks were confirmed at three primary schools yesterday, the Centre for Health Protection said on its Web site. The outbreak is suspected to have spread to 20 other schools, it said.

Last week, 13 cases were confirmed, still below the peak of 22 recorded during 2007’s flu season, the center, part of the government’s health department, said. Hospital admission rates due to flu among children younger than five years old and the elderly, while rising, are still below those recorded during the peak seasons in the past two years, the center said.

Hong Kong had 140,783 kindergarten and 410,516 primary students the school year ended July 2007, according to the Hong Kong Education Bureau’s Web site. The closures affect children aged between 3 and 11.

Resistant Viruses

The current northern hemisphere flu season is the strongest in four years, and hasn’t been this severe this late in the season in more than 10 years, said Craig Maxwell, a JPMorgan Chase & Co. health-care analyst in London, in a note to clients.

The jump in flu cases is happening because this year’s vaccine is effective against fewer than half the strains infecting people, according to the U.S. Centers for Disease Control and Prevention in Atlanta.

Scientists have also found strains of the H1N1 seasonal flu virus capable of evading Roche Holding AG’s Tamiflu antiviral drug in 20 countries in Europe, North America and Asia-Pacific during the past three months.

The prevalence of resistant viruses ranges from 3 percent in Australia to 66 percent in Norway. In Hong Kong, 11 out of 116 samples from patients infected with the H1N1 virus harbored resistance to the pill, the World Health Organization said in a statement on March 6.

Source: Bloomberg
http://www.bloomberg.com/apps/news?pid=20601087&sid=aVeAzaASQsLE&refer=home

At some point during last month’s well-baby checkup for her son Isaac, Kamila McGinnis stopped listening to her pediatrician.

Isaac, who turns 3 in June, hasn’t shown much interest in toilet training. McGinnis wants him out of diapers and encourages him to use the potty. But, she says, her pediatrician told her to back off.

“She said, ‘He’ll know when it’s the right time for him,’ that it’s important to let him do it on his own,” says McGinnis, the mother of three in Timonium, Maryland. “In the back of my mind, I said to myself, ‘I disagree.’ I felt like my pediatrician was saying she knew more than I did.”

In many ways, pediatricians do know more than parents. When your doctor says your newborn needs to ride in a rear-facing car seat, don’t argue. When he says your 2-month-old with a 105-degree fever needs to get to the doctor’s office — and fast — you’d better listen.

But there are far more areas that are gray and have no science, or not very good science, to back them up, says our panel of pediatric experts. They say that sometimes, this means your pediatrician is giving you his or her opinion, not medical fact.

“There are several ways to approach many issues in pediatrics. There isn’t one clear-cut way,” says Dr. Robert Needlman, co-author of the latest edition of Dr. Spock’s Baby and Child Care. “Pediatricians really should make a distinction between what’s based on research and what’s based on our own particular beliefs.”

Since pediatricians don’t always make that distinction clear, here are examples of five parenting issues where there’s plenty of room to disagree with the pediatrician.

1. ‘Don’t pick up your baby in the middle of the night’

Dr. Jennifer Shu, a pediatrician in Atlanta, Georgia, and co-author of Heading Home with Your Newborn, says parents tell her all the time that their pediatricians have given them directives about their baby’s sleep.

“Parents tell me, ‘My pediatrician told me to let my baby cry it out, that they should be sleeping through the night without eating,” says Shu, a spokeswoman for the American Academy of Pediatrics. “Rather than make the parent feel awful, we ought to have some latitude, some flexibility.”

Dr. Joyce Zmuda, a pediatrician in private practice in Owings Mills, Maryland, says she tells patients there’s lots of “wiggle room” on this issue. “They have to first understand that if they go to their baby in the middle of the night, they’re creating an expectation that the parent will always be there when they cry,” she says. “But if they understand that and just can’t stand to hear the baby crying and want to go to them, that’s fine with me. It’s a personal decision.”

2. ‘Baby should be at home with Mom’

Some pediatricians tell parents it’s best if baby stays at home until a certain age.

“There’s been a whole debate about this in the psychological literature,” Needlman says. “And the bottom line is that the timing of the day care isn’t as important as the quality of the day care. Poor-quality day care is bad for a kid at any age, as is poor-quality home care.”

He says that if your pediatrician tells you it’s best for your child to stay at home, this is just an opinion. “There was a time we thought a child younger than 3 in the care of anyone but the mother was just horrifying. That belief has been well, well dispelled,” he says.

3. ‘Don’t give your baby ‘triple nipple confusion”

If your pediatrician (or lactation counselor) tells you not to give your baby a bottle or pacifier because the baby might get “triple nipple confusion,” take it with a grain of salt, our experts tell us.

Dr. Hope Hamilton-Rodgers, a pediatrician in private practice in Rome, Georgia, says there’s not a lot of research to back up this assertion. “I have plenty of patients who do bottle, breast and pacifier from the get-go and don’t have nipple confusion,” she says.

Dr. Laura Jana, Shu’s co-author of the newborn book and of Food Fights, a nutrition book for parents and kids, says some newborns do experience nipple confusion, so she offers this advice: “I tell them if they’re concerned about nipple confusion, they can do just breastfeeding for a week or two to make sure their baby’s getting the hang of it, and then if everything’s working OK, try a paci or a bottle if they want.”

4. ‘Your baby must eat solid foods by 6 months’

The standard advice for parents is to start their babies on solids sometime between 4 and 6 months of age. But if your baby’s that age and isn’t interested in real food and wants to get all his calories by breast milk or formula, there’s no reason to panic, Shu says. “Some are just slower to take to the textures of food and want just the bottle or the breast.”

Jana, a spokeswoman for the American Academy of Pediatrics, says all children are different. She remembers one of her three children was unenthusiastic about food until she was 9 months old. “My son, on the other hand, at 4 months old cried between spoonfuls because it wasn’t coming fast enough,” she says.

Needlman agrees there’s no reason to panic if your 6-month-old doesn’t want to eat solid food, but it’s a good idea to visit the pediatrician to make sure the dislike is just your baby’s personal preference and not a sign of a health problem.

5. ‘You must take the pacifier away’

Some pediatricians get very opinionated about the age at which to wean a child off the pacifier. But our experts say as long as it’s not interfering with the child’s speech, or causing dental problems, it’s OK to let a child soothe herself with a pacifier.

“There’s not a lot of science on this,” Shu says. “It’s not cut and dried by any means.”

The bottom line: when you’re in the pediatrician’s office, you should try to separate medical fact from medical opinion.

This isn’t always easy.

“This is a big deal for mothers and even bigger for new mothers who trust their judgment even less,” says Mia Redrick, a “mom coach” and author of Time for mom-ME. “Often it’s hard for mothers to distinguish medical advice from a pediatrician’s personal opinion.”

Needlman offers this advice: If you’re not sure if you’re getting fact or opinion, ask. “It’s a good thing when a parent says ‘Really? I don’t want to do that,’” he says. “You can challenge your pediatrician along the lines of saying, ‘That advice you gave me doesn’t feel comfortable to me. Can we talk about some other options?’”

Source: CNN
http://www.cnn.com/2008/HEALTH/family/03/13/ep.pediatrician.advice/