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/

Think-tank demands ban on hitting youngsters

Smacking children, however lightly, should be outlawed because it increases the chances of aggression and anti-social and criminal behaviour in later life, a new report concludes.

An outright ban would ‘reduce criminality in the long run but also send out a message about the kind of society we want to be, according to the study by the Institute for Public Policy Research.

The think-tank, which is close to the government, also calls for children to be given cognitive behavioural therapy from the age of five, in an attempt to stop them turning into teenage criminals.

‘The evidence shows that the most prolific criminals start offending between the ages of 10 and 13,’ said Julia Margo, associate director at IPPR and author of Make Me A Criminal, Preventing Youth Crime. ‘You need to deal with the problem before it manifests. The biggest risk factor is not their behaviour, but their parents.‘

Instead of punishing young children with anti-social behaviour orders, specialists should look into whether their parents were condoning delinquent behaviour, Margo argued. She called for ’sure start plus’ centres for children aged five to 12, through which parenting classes, one-to-one reading sessions and counselling could be carried out.

But Margo said a total ban on smacking would also reduce the number of children turning to crime. ‘There is a lot of evidence that children who are smacked regularly - once a week - are more likely to develop aggressive personality disorder,’ said Margo. ‘Hitting a child teaches them to act out on emotional impulses. We need to give out the message that children should be nurtured and taught to manage their behaviour. We should ban corporal punishment properly.’

It is currently not lawful for a parent to smack a child if it leaves a bruise but a lighter smack or ‘reasonable chastisement’ is allowed.

It is a policy that many doctors oppose. ‘This is an extremely important report,’ said Rosalyn Proops, the child protection officer at the Royal College of Paediatrics and Child Health. ‘Like all people, paediatricians have a variety of opinions. However, the majority believe that all forms of smacking are an assault of a child and should not take place.‘

But others argued that making smacking illegal would be unfair on those parents who did not know how else to punish their children.

Alex Griffiths, an educational psychologist, said any ban would have to be met with an educational programme: ‘My worry is that before it can be made illegal parents need realistic alternatives as to how they should handle their children. Otherwise, a large group of people, whose children are out of control, will be left with no sanctions whatsoever.’

Parents, meanwhile, congratulated the government for not banning smacking completely. Andy Hibberd, co-founder of the Parent Organisation, said: ‘If you can reason with a child in any other way then you should. But can you reason with a two-year-old who is reaching for a hot pan? Parents should be able to use a smack as a sanction - not in a way that will injure a child. Sometimes a short, sharp slap is a reminder to the child.’

A spokeswoman for the Department for Schools and Families said they were not prepared to change the laws on smacking, arguing that violence against a child was illegal but decent parents should not be criminalised.

Source: The Observer, UK
http://www.guardian.co.uk/society/2008/feb/10/children.justice

The largest study to date says the vaccine for measles, mumps and rubella (MMR) does not cause the developmental disorder autism.

The research was led by researchers with the Newcomen Centre for Child Development in England and published Tuesday in the journal, Archives of Disease in Childhood.

It also confirms what the Canadian Pediatric Society has been saying for some time, a spokesman said.

“This adds yet another study that has demonstrated that there is no relationship between immunization and autism.

“And that is something that has been found again and again when it’s been looked at in any systematic fashion,” said Dr. Robert Bortolussi, chairman of the society’s Infectious Diseases and Immunization Committee.

The study refutes the controversial findings of Dr. Brian Wakefield published in the medical journal, The Lancet in 1998 which indicated a link between the MMR vaccine and autism.

The claims led to a decrease in immunization rates in Britain.

“We have not observed a significant impact on coverage or uptake of MMR or other vaccines in National Immunization Coverage Surveys results since that time,” said Alain Desroches, a spokesman for Canada’s Public Health Agency. (…)

“This study really supports the view these are safe vaccines,” David Brown, a researcher at Britain’s Health Protection Agency told Reuters.

“The evidence is now so solid there really isn’t a need for further studies here,” he said.

Bortolussi said the claims linking autism to the MMR vaccine were not founded on good evidence, but they did lead some parents to reject vaccines.

“By doing that, they place not only themselves but society as a whole at risk,” he said. (…)

Source: Canada.com, Canada
http://tinyurl.com/352ed6