Tuesday, May 27, 2008

Vitamin D Below Essential Levels for Children?

The current recommended daily allowance (RDA) of vitamin D for children is 200 International Units (IUs), but new research reveals that children may need and can safely take ten-times that amount. According to a recently accepted report in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM), this order-of-magnitude increase could improve the bone health of children worldwide and may have other long-term health benefits.

“Our research reveals that vitamin D, at doses equivalent to 2,000 IUs a day, is not only safe for adolescents, but it is actually necessary for achieving desirable vitamin D levels,” said Ghada El-Haff Fuleihan, M.D., of the American University of Beirut-Medical Center, Lebanon, and lead author of the study.

Vitamin D is an essential hormone for bone growth and development in children and promotes skeletal health in adults. Currently, the National Academy of Sciences’ Institute of Medicine recommends an adequate daily intake of 200 IUs of vitamin D for children. This is also the recommendation from the American Academy of Pediatrics. These levels, however, may not be adequate for bone growth and musculoskeletal health in children and adolescents.

“Data on appropriate vitamin D levels in the pediatric age group are lacking,” said Dr. Fuleihan. “This is a major obstacle to finding the right daily allowance to enhance musculoskeletal health.”

To help clarify these important guidelines, Fuleihan and his colleagues conducted both short- and long-term trials to gauge the safety of relatively high doses of vitamin D3 in children ages 10-17 years.

Vitamin D3 is one of the most common forms of vitamin D, and is easily converted to 25-OHD (25-hydroxyvitamin), which is the active form of vitamin D found in the blood.

For this placebo-controlled study, researchers gave children various doses of vitamin D at various intervals and measured the impact this had on serum levels of 25-OHD.

For the short-term study, 25 students (15 boys and 10 girls) received one-weekly, 14,000 IU doses of vitamin D for eight weeks. Serum levels of 25-OHD were then measured for an additional eight weeks. This portion of the test was conducted during the summer and early fall, when the highest natural levels of vitamin D are reached.

For the long-term, one-year study, 340 students (172 boys and 168 girls) received either a low dose of vitamin D (1,400 IUs each week) or a high dose (14,000 IUs each week).

Only children given the equivalent of 2,000 IUs a day of vitamin D increased 25-OHD levels from the mid-teens to the mid-thirties (ng/ml)—the level considered optimal for adults. None of the children in either trial showed any evidence for vitamin D intoxication.

Although many experts agree that a 25-OHD level of 30 ng/ml is desirable in adults, what constitutes an optimal D level for children and adolescents is more debatable. According to the researchers, due to rapid skeletal growth, children and adolescents are more likely to be vitamin D deficient, and are far less likely to reach vitamin D levels that doctors would consider toxic.

“Supplementation of children and adolescents with 2,000 IUs a day of vitamin D3 is well tolerated and safe,” said Dr. Fuleihan. “This is particularly relevant in light of the increasingly recognized health benefits of vitamin D for adults and children.”

Other researchers involved in the study include Joyce Maalouf, Mona Nabulsi, Reinhold Vieth, Samantha Kimball, Rola El-Rassi, and Ziyad Mahfoud.

The study “Short term and long term safety of weekly high dose vitamin D3 supplemetnation in school children” will be published in the July issue of JCEM.

Thursday, May 15, 2008

Too Much Water Raises Seizure Risk in Babies

It’s a recurrent summer-time scenario in the pediatric emergency room and doctors from Johns Hopkins Children’s are sounding the alarm on it: An otherwise healthy infant is brought in by panicked parents after suffering a seizure, which turns out to be caused by drinking too much water.

Pediatricians at Hopkins Children’s see at least three or four such cases every summer, and while the seizures are benign and have no lasting effect on a child’s health, they are quite dramatic and completely preventable, doctors say.

“Babies need extra fluids in the hot weather, but straight water is not one of them,” says pediatrician Allen Walker, M.D., head of the Emergency Department at Hopkins Children’s. “A parent’s natural instinct is to give the baby water to prevent dehydration, but too much water can disrupt the delicate balance in a baby’s body, leading to water intoxication. Before you know it, the baby is seizing.”

Too much water dilutes sodium in the blood and flushes it out of the body, thus altering brain activity, which can lead to a seizure. Infants under 1 year of age may be more prone to these types of seizures than older children because a young infant’s diet does not contain enough food sources to replenish the lost sodium. Also, an infant’s immature kidneys cannot flush out excess water fast enough, causing a dangerous buildup of water in the body.

Breast milk and formula are the best way to keep a child under 1 year of age who is not eating solid foods hydrated, Walker says, and straight water should be avoided. Over-diluted formula can lead to water intoxication as well. Electrolyte-enriched pediatric drinks are not recommended for routine hydration.
Symptoms of water intoxication in an infant include:

• changes in mental status, i.e., unusual irritability or drowsiness
• low body temperature, usually 97 degrees or less
• facial swelling or puffiness
• seizures

Though any infant who consumes too much water can suffer water intoxication, the risk is highest among children who are already dehydrated, typically after a bout with viral or bacterial infections that cause vomiting and diarrhea. Symptoms of dehydration in a young child include dry mouth, increased thirst, irritability and reduced sweating and urination. An easy way to spot dehydration is if a child has fewer than three wet diapers in 24 hours, Walker says.

In otherwise healthy infants, water intoxication is one of the leading triggers of seizures. The most common type of childhood seizures are febrile seizures, occurring in 2 to 5 percent of all children under 5 years of age, according to the American College of Emergency Physicians.

Cough medicines for under-2s despite warnings

tudy finds
More than 40 per cent of parents have used cough medicine for children younger than two – even though it is not recommended, nor proven effective for children in this age group, an Australia-first study has found.

The joint University of Melbourne and Royal Children’s Hospital study, surveyed 325 parents at hospital outpatient clinics, maternal child health centres and child care centres about their use of over-the-counter medication for children aged 0-24 months.

It is the first study in Australia examining the use of over-the-counter medications among parents of children in this age group.

University of Melbourne Nursing PhD researcher Misel (pronounced Michelle) Trajanovska will present data from her study at the National Medicines Symposium 2008 in Canberra tomorrow (Friday 16 May).

She found:

98 per cent had purchased an over-the-counter medication in the past year;
Paracetamol was the most commonly used drug (95.9 per cent);
47.3 per cent had given their children topical teething gels;
Almost half (42.8 per cent) had given their children cough and cold medicines containing anti-histamines;
Nearly all parents had used over the counter medications to combat pain and fever;
About seven per cent of parents had given their child over-the-counter medication to induce sleep or settle their child;
Two parents had given their children paracetamol because they were “cranky”.
Ms Trajanovska said the use of cough and cold medicines on children under two was of particular concern.

“Internationally there have been a number of reports of serious side effects among infants and children given over-the-counter cough medicines,’’ she said.

“There is also a lack of evidence that these medicines are even effective for treating coughs.

“The Therapeutic Goods Administration recommends that these medicines should not be used on children under two, and from September they will only be available to children under two on prescription.”

Ms Trajanovska said the survey results reinforced the need for continued education of parents about the safe use of over-the-counter medicines.

“Despite the widespread use of over-the-counter medicines for young children, they are not without risks such as side effects or poisoning,” she said.

Ms Trajanovska said that in Victoria 0-4 year olds had the highest poisoning admission rates. In emergency departments 16 per cent of these poisonings were due to paracetamol and 11 per cent were caused by cough and cold medicines.

Wednesday, May 7, 2008

Weight Gain Poses Risks to Pregnant Mothers, Babies

Women who gain more or less than recommended amounts of weight during pregnancy are likely to increase the risk of problems for both themselves and their child, according to a new report by the RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center.

The report, which was supported by the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ) in partnership with the American Dietetic Association, is based on a systematic review of 150 studies that assessed the short- and long-term effects of maternal weight gain on pregnancy, mothers, fetuses, and children. The studies were published in English between January 1990 and October 2007.

Among the report’s key findings is a strong association between high maternal weight gain and increased fetal growth and infant birth weight, which can contribute to complications during labor if a baby is too big, and can lead to long term health effects for the child. High maternal weight gain also is associated with cesarean delivery and weight retention by mothers after childbirth.

The review also confirmed that gaining too little weight during pregnancy can be a problem. Low maternal weight gain is associated with poor fetal growth, lower birth weight, and the chance of a baby being born prematurely.

The report was prompted by several trends, including an increase in the number of American women who are overweight and obese, as well as the number who gain more weight during pregnancy than amounts laid out in the Institute of Medicine’s 1990 recommendations for maternal weight gain. Public health officials also are concerned about an increase in pregnancy complications such as diabetes and cesarean delivery.

The Institute of Medicine is currently reviewing its pregnancy weight guidelines to see if they need to be revised; it expects to issue a report next summer.

“Unfortunately, the existing body of research on maternal weight gain is inadequate to permit a more comprehensive assessment,” said Meera Viswanathan, Ph.D., the study director and a senior research analyst at RTI International. “Most beneficial would be an analysis that considers the risks and potential benefits of various maternal weight-gain scenarios to all women – irrespective of age, race or ethnicity, or their body mass index before they became pregnant. But such an analysis is not possible at this time.”

Her research colleague at UNC, Anna Maria Siega-Riz, Ph.D., agreed.

“Despite the large body of research, clear clinical recommendations based on this systematic review will be challenging to formulate because of major shortcomings in this research,” said Siega-Riz, an associate professor in the UNC School of Public Health’s epidemiology and nutrition departments. “To fully understand the effects of maternal weight gain on short- and long-term health outcomes for both women and infants, future studies will need to adopt standard measures and consistent definitions of exposures and outcomes.”

The researchers said future studies will need to examine multiple outcomes within the same study population to explore fully the trade-offs between the risks and benefits to the mother and to the child.

Along with Viswanathan and Siega-Riz, the other authors of the report are Merry-K Moos, a research professor in the obstetrics and gynecology department in the UNC School of Medicine, and an adjunct professor in the schools of Nursing and Public Health; Andrea Deierlein, a research assistant and doctoral student in the nutrition department in the School of Public Health; Sunni Mumford, a doctoral student in the epidemiology department in the School of Public Health; Julie Knaack, program assistant in the maternal and child health department in the School of Public Health; Patricia Thieda, project coordinator at UNC’s Cecil G. Sheps Center for Health Services Research; and Linda J. Lux and Kathleen N. Lohr, Ph.D., from RTI International.

The report can be found on AHRQ’s Web site at: http://www.ahrq.gov/clinic/tp/admattp.htm.

Monday, May 5, 2008

1 in 10 children using cough, cold medications

1 in 10 children using cough, cold medications

Researchers from Boston University’s Slone Epidemiology Center have found that approximately one in ten U.S. children uses one or more cough and cold medications during a given week.

Pediatric cough and cold medications are widely marketed in the U.S. but surprisingly little is known about just how often they are used in children. This information is especially important in light of recent revelations that cough and cold medications are responsible for serious adverse events and even deaths among children.

To define the frequency and patterns of use, the researchers analyzed data between 1999 and 2006 from the Slone Survey, a national telephone survey of medication use in a representative sample of the U.S. population. The authors considered all oral medicines that are approved by the FDA to treat children’s coughs and colds.

The researchers found that in a given week, at least one cough and cold medication was used by 10.1 percent of U.S. children. In terms of active ingredients contained in these medications, exposure was highest to decongestants and antihistamines (6.3 percent each), followed by anti-cough ingredients (4.1 percent) and expectorants (1.5 percent).

Exposures to cough and cold medications was highest among 2 to 5 year olds, but was also high among children under 2 years of age.

Among all the products used, 64.2 percent contained more than one active ingredient. The most commonly used product types were single-ingredient antihistamines, antihistamine/decongestant combinations and antihistamine/decongestant/anti-cough combinations. The researchers also found the use of cough and cold medications declined from 12.3 percent in 1999-2000 to 8.4 percent in 2005-2006.

According to the researchers the especially common use of cough and cold medications among young children is noteworthy. “Given concerns about potential harmful effects and lack of evidence proving that these medications are effective in young children, the fact that one in ten U.S. children is using one of these medications is striking,” said lead author Louis Vernacchio, MD, MSc, an assistant professor of epidemiology and pediatrics at Boston University School of Medicine.

Fixing up 'this old house' = lead hazard

Ripping out and tearing down to create a divinely designed home, a la HGTV, is all the rage today – and the economic downturn may be leading more families to renovate rather than relocate. But a new study has found that parents need to be aware that all this interior renovation can put their children's health at risk due to exposure to lead.

The study conducted by researchers at Cincinnati Children’s Hospital Medical Center found that interior renovation of older housing is associated with a modest increase in children’s blood lead level (BLL) and associated long-term health risks. These findings will be presented by co-author Stephen Wilson, M.D., at the Pediatric Academic Society (PAS) annual meeting in Honolulu on May 3.

“Any person working on a home where children reside or visit frequently should know that their renovation work could cause lead hazards for the kids if the home was built before 1978, when the government banned lead-based paint in housing,” said Adam Spanier, M.D., Ph.D. M.P.H., the study’s lead author and director of the Pediatric Environmental Health and Lead Clinic at Cincinnati Children’s Hospital Medical Center.

The study of 249 children, all living in homes built before 1978, found that those who resided in houses where renovations had been done had higher blood lead levels than those in houses where no renovating had been done. Researchers used multivariable analysis to find that the kids who had lived through renovation projects had a 12 percent increase in mean BLL by age 2 compared with other children (p<0.01). The increase in BLL seemed related directly to the renovation work, given that if renovation took place within one month prior to measurement, 2-year-old children had a 1.6 micrograms per deciliter increase in average BLL and if the renovation was more recent (within a month before blood tests were done), compared to an average jump of 0.8 micrograms per deciliter in children whose houses had been renovated two to six months before measurement (p<0.01).

The researchers also noted an association between high lead concentration in the building’s existing paint and the child’s BLL. Specifically, for every 10 milligram per square centimeter increase in paint lead concentration, there was a 7.5 percent increase in average blood lead levels (p=0.02).

Some research studies have shown that children’s BLL below 7.5 is associated with intellectual impairment and affects brain development.

“Toxic agents such as lead could have long-term effects on children’s brain development even as early as when they are fetuses,” said Dr. Spanier. “If lead poisoning goes undetected and untreated in children, it has the potential to result in a number of neurodevelopmental issues, including ADHD and learning problems.”

During renovations, most children are exposed to lead paint dust that is disturbed by the work. If precautions are not taken, this lead paint dust may settle on surfaces and could be spread in the air inside the house through interior ventilation systems. Although the study looked at children between the ages of 6 to 24 months, Dr. Spanier cautioned that all young children, particularly those under 6 years, are considered most at risk.

”There are risks to renovating older homes, but there also are lots of ways parents can reduce the risk of lead exposure to their children,” Dr. Spanier said. “It’s also more cost effective to avoid the problem than to treat an already exposed child. Preventing exposure is the key.”

If parents are unsure about the paint or other lead hazards in their home, Dr. Spanier suggested they should call the National Lead Information Center, provided by ABVI Good Will, at 1-800-424-LEAD or visit the Environmental Protection Agency’s website at www.epa.gov/lead for more information on local labs that can test lead paint. If there are hazards professional abatement is the best option.

However, if abatement of the lead is not an option, there are a few precautions do-it-yourself rehabbers can take while renovating homes.

Attach a High Efficiency Particulate Air, or HEPA, vacuum to all power tools and use a HEPA vacuum to clean up the area
Use heavy plastic to cover doorways, windows, floors, and any furniture that can’t be removed from the renovated area and to dispose of all trash and debris
Block off and shut off air conditioning or heating vents in the work area
Close windows and doors in or near the work area
Mist paint before sanding or scraping
Keep everyone not working in the area out and, if possible, have the children stay at a friend or relatives while the work is being done
Use personal protective devices (masks, gloves, etc)
Seek training in lead safe work practices
Also, if parents hire a contractor to do their home renovations, it’s important to choose someone who has gone through lead safety training.

If parents who have done renovations are worried about their child’s lead levels or are concerned they may have been exposed to lead dust from building renovations, a pediatrician or family practitioner can order a lead test for the child. This will allow them to determine the child’s lead level and recommend treatment if needed. Several treatment options available, depending on the blood lead levels detected.

“Not having lead hazards in homes would be the goal, but for now, it is important to know lead’s health risks to children and what adults can do to avoid them,” said Dr. Spanier.

US parents don't know what to expect of infants

Nearly one-third of US parents don't know what to expect of infants

Lack of parenting savvy leads to unrealistic expectations, poorer interactions

Almost one-third of U.S. parents have a surprisingly low-level knowledge of typical infant development and unrealistic expectations for their child’s physical, social and emotional growth, according research from the University of Rochester. The new findings, which suggest that such false parenting assumptions can not only impair parent-child interactions, but also rob kids of much-needed cognitive stimulation, will be presented Sunday, May 4, at the Pediatric Academic Society meeting in Honolulu, Hawaii.

“There are numerous parenting books telling people what to expect when they’re pregnant,” said Heather Paradis, M.D., a pediatric fellow at the University of Rochester Medical Center. “But once a baby is born, an astonishing number of parents are not only unsure of what to anticipate as their child develops, but are also uncertain of when, how or how much they are to help their babies reach various milestones, such as talking, grabbing, discerning right from wrong, or even potty-training.”

Moms and dads often misinterpret behaviors – some parents expect too much of babies too soon and grow frustrated; others underestimate their child’s abilities, preventing them from learning on their own.

Using data from the Early Childhood Longitudinal Study’s Birth Cohort (ECLS-B), Paradis and her colleagues analyzed the average parenting knowledge of a nationally-representative sample of parents of more than 10,000 9-month-old babies. These parents first answered an 11-point survey designed to distinguish informed parents from less-informed parents (asking questions such as “Should a 1-year-old child be able to tell between right from wrong"” and “Should a 1-year-old child be ready to begin toilet-training"”). Those who scored 4 or fewer correct answers were considered to have low-level knowledge of typical infant development.

Paradis and colleagues then compared these knowledge scores to both scores from (1) a 73-point videotape analysis of the same families’ parent-child interactions while teaching a new task, and (2) from these parents’ self-reports of how often they engaged their child in enrichment activities (e.g. reading books, telling stories, or singing songs).

The analysis revealed that 31.2 percent of parents of infants had low-level knowledge of infant development, and that this low-level knowledge correlated with lower parental education level and income. Still, even when controlling for maternal age, education, income and mental state (e.g., depression), low-level knowledge of infant development still significantly and independently predicted parents being both less likely to enjoy healthy interactions with their infants during learning tasks and less likely to engage their children in regular enrichment activities

“This is a wake-up call for pediatricians,” Paradis said. “At office visits, we have a prime opportunity to intervene and help realign parents’ expectations for their infants, and in turn, promote healthy physical, social, and emotional development for these children. On the other hand, we still have more work cut out for us – additional research is needed to explore how these unrealistic expectations form in the first place.”

Children more vulnerable to harmful effects of lead

Contrary to prevailing assumptions, children are more vulnerable to the harmful effects of lead exposure at the age of 6 than they are in early childhood, according to a Cincinnati Children’s Hospital Medical Center study to be presented May 4 at the annual meeting of the Pediatric Academic Societies in Honolulu.

“Although we typically worry about protecting toddlers from lead exposure, our study shows that parents and pediatricians should be just as, if not more concerned about lead exposure in school-aged children,” says Richard Hornung, Dr.P.H., a researcher in the division of general and community pediatrics at Cincinnati Children’s and the study’s main author.

The researchers found that blood lead concentrations (BPb) at age 6, compared to those at younger ages, are more strongly associated with IQ and reduced volume of gray matter in the prefrontal cortex of the brain, which is involved in planning, complex thinking and moderating behavior.

Overall, the children’s average BPb levels peaked at 13.9 micrograms of lead per deciliter of blood at age 2, then declined to an average of 7.3 micrograms per deciliter by age 6. For children, however, with the same average blood lead levels through age 6, those who received more of their exposure at age 6 had substantially greater decrements in intellectual ability than those more heavily exposed at age 2.

“Lead toxicity is difficult to recognize in a clinical setting, but it can have devastating effects,” says Bruce Lanphear, M.D., director of the Cincinnati Children’s Environmental Health Center and the study’s senior author. “We found that children may be particularly vulnerable to lead exposure just as the child approaches school age, during a period of rapid cognitive development.

Because IQ tests were not administered to children older than 6, it is unknown whether older children are even more vulnerable to environmental lead exposure, according to Dr. Hornung.

Approximately 310,000 U.S. children age 1 to 5 years have blood lead levels greater than 10 micrograms per deciliter, the level at which the Centers for Disease Control and Prevention recommends public health actions be initiated. But research has consistently shown that blood lead levels considerably lower than 10 micrograms per deciliter are associated with adverse effects.

Federal and state regulatory standards have helped to minimize or eliminate the amount of lead in U.S. consumer products and occupational settings, according to the National Institute of Environmental Health Sciences (NIEHS). Today, the most common sources of lead exposure in the United States are lead-based paint in older homes, contaminated soil, household dust, drinking water, lead crystal and lead-glazed pottery.

While extreme lead exposure can cause a variety of neurological disorders, such as lack of muscular coordination, convulsions and coma, lower lead levels have been associated with measurable deficits in children’s mental development and behavioral problems. These include hyperactivity, or ADHD, lowered performance on intelligence tests, and deficits in fine motor function, hand-eye coordination and reaction time. Chronic lead exposure in adults can result in increased blood pressure, decreased fertility, cataracts, nerve disorders, muscle and joint pain as well as problems with memory or concentration.

Iron supplements harm infants who have enough

A new study suggests that extra iron for infants who don't need it might delay development -- results that fuel the debate over optimal iron supplement levels and could have huge implications for the baby formula and food industry.

"Our results for 25 years of research show problems with lack of iron. For us to find this result is a big deal, it's really unexpected," said Dr. Betsy Lozoff, University of Michigan research professor at the Center for Human Growth and Development, and the study's principal investigator.

U.S. infant formulas typically come fortified with 12 mg/L of iron to prevent iron-deficiency anemia. Europe generally uses a lower amount. In infants, iron-deficiency anemia is associated with poorer development, and during pregnancy it contributes to anemia in mothers, contributing to premature birth, low birth weight and other complications.

"I thought that behavior and development would be better with the 12 mg formula," said Lozoff, also professor of pediatrics in the U-M Department of Pediatrics and Communicable Diseases at the Medical School and C.S. Mott Children's Hospital

The U-M study of 494 Chilean children showed that those who received iron fortified formula in infancy at the 12 mg used in the U.S. lagged behind those who received low-iron formula in cognitive and visual-motor development by age 10 years. Lozoff stressed that most children who received the 12 mg formula did not show lower scores. But the 5 percent of the sample with the highest hemoglobin levels at 6 months showed the poorest outcome. Your body needs iron to make hemoglobin, a substance in red blood cells that enables them to carry oxygen. High hemoglobin generally indicates sufficient iron.

Adversely affected children scored 11 points lower in IQ and 12 points lower in visual-motor integration, on average; the average overall score on both tests was 100. A similar pattern was observed for spatial memory and other visual-motor measures.

Lozoff noted that not many infants in Chile had high hemoglobin levels at the time since there was no iron-fortification program for infants and that more than 5 percent of U.S. infants might have high hemoglobin levels in early infancy.

In this randomized study, healthy infants without iron-deficiency anemia were given formula with either 12 mg or 2.3 mg iron from 6 to 12 months and followed to 10 years. The next step is to test the participants again at age 16, Lozoff said, who says that no such study has been conducted in the United States or elsewhere.

Iron deficiency occurs because babies grow so quickly they often "grow out" of the amount of iron they are born with. Breast milk is thought to contain the iron a baby needs for 4-6 months, Lozoff said. Other important sources of iron for infants include iron-fortified infant formulas and cereals, iron drops and meat.

Infants are typically not tested for hemoglobin or iron levels before 9-12 months. It would be premature to recommend earlier testing or to avoid supplemental iron based on the study's results, Lozoff said. She expects parents to be concerned, but stressed that results must be reproduced in other studies.

"At this point there's no basis for changing practice, but it's really important that we have continued research on this issue," she said.

Children's physical activity in child care

Flip flops, mulch and no coat

First phase of NHLBI-sponsored study on children's physical activity in child care

At a time when over half of US children (aged 3-6) are in child care centers, and growing concern over childhood obesity has led physicians to focus on whether children are getting enough physical activity, a new study of outdoor physical activity at child care centers, conducted by researchers at Cincinnati Children’s Hospital Medical Center, has identified some surprising reasons why the kids may be staying inside. The study, will be presented May 5 at the annual meeting of the Pediatric Academic Societies in Honolulu, Hawaii.

“It’s things we never expected, from flip flops, mulch near the playground, children who come to child care without a coat on chilly days, to teachers talking or texting on cell phones while they were supposed to be supervising the children,” according to Kristen Copeland, M.D., lead author of the study which was funded by the National Heart, Lung and Blood Institute. She noted that because there are so many benefits of physical activity for children – from prevention of obesity, to better concentration and development of gross motor skills – it’s important to know what barriers to physical activity may exist at child-care centers.

“With so many American preschool-aged children in child care centers, and previous reports that the amount of physical activity children get varies widely across different centers, we wanted to explore what some of the barriers to physical activity at these centers might be,” said Dr. Copeland, a physician scientist and Assistant Professor of Pediatrics in the Division of General and Community Pediatrics at Cincinnati Children’s. According to the most recent statistics 74% of US children aged 3-6 years are in some form of non-parental child care. 56% percent of 3-6 year old children spend time in centers, including child care centers and preschools. Her team began by exploring child-care center staff members’ perceptions of barriers to children’s physical activity. They conducted focus groups with 49 staff members from 34 child-care centers in the Cincinnati area (including Montessori, Head Start and centers in the inner city and suburban areas) as the first of several studies on this subject.

“We found several previously unreported barriers that meant kids had to stay inside, including inappropriate footwear such as flip flops and inappropriate clothing for the weather,” said Dr. Copeland. In some child care centers, if one child in the group shows up without a coat on a chilly day, she noted, that means the whole group has to stay inside. Even more surprising to the researchers was the fact that the child-care staff members said some parents appear to intentionally keep their children’s coats (or send children without coats) so they’d have to stay inside, which staff attributed to parents’ concerns about the child getting injured or dirty, or a having a cold that may be exacerbated by cold weather.

Teachers said they also felt pressure from some parents who were more concerned with children spending time on cognitive skills, such as reading and writing, than on the gross motor and socio-emotional skills (such as kicking a ball or negotiating with another child for a turn on the slide) that are best learned on the playground.

Then there was the mulch factor. “The staff members who participated in the groups were really concerned about mulch in the play area,” said Dr. Copeland. “Many said that the kids eat the mulch, or use it as weapons, or it gets caught in their shoes. It also requires constant upkeep. It’s certainly not something that we had anticipated as an issue, but judging by the amount of and intensity of the discussions among child care teachers, it really is.”

Dr. Copeland said the child-care center staff recognized that they themselves could sometimes serve as a barrier to children’s physical activity. “We heard reports of teachers talking or texting on cell phones instead of interacting with the children while on the playground,” said Dr. Copeland. She continued, “We found that a staff member who doesn’t like going outside—maybe she’s not a cold-weather person, or she thinks it’s too much work to bundle up and unbundle the children on a cold day — could act as a gatekeeper to the playground.” In some cases, staff reported that their own issues with being overweight prevented them from encouraging children’s physical activity.

“This initial qualitative research has identified a number of issues that we will be exploring in subsequent studies,” noted Dr. Copeland. “Clearly this is a complex issue –But finding out what the barriers are is the first step in addressing the problem and getting more kids involved in more much-needed physical activity.”

Study links breastfeeding to increased intelligence

Prolonged and exclusive nursing improves children's cognitive development

The largest randomized study of breastfeeding ever conducted reports that breastfeeding raises children’s IQs and improves their academic performance, a McGill researcher and his team have found.

In an article titled, Breastfeeding and Child Cognitive Development, published in the current issue of the Archives of General Psychiatry, Dr. Michael Kramer reports the results from following the same group of 14,000 children for 6.5 years.

"Our study provides the strongest evidence to date that prolonged and exclusive breastfeeding makes kids smarter," said Kramer, a Professor of Pediatrics and of Epidemiology & Biostatistics in the McGill University Faculty of Medicine and lead investigator in the study.

Kramer and his colleagues evaluated the children in 31 Belarusian hospitals and clinics. Half the mothers were exposed to an intervention that encouraged prolonged and exclusive breastfeeding. The remaining half continued their usual maternity hospital and outpatient pediatric care and follow-up. This allowed the researchers to measure the effect of breastfeeding on the children’s cognitive development without the results being biased by differences in factors such as the mother’s intelligence or her way of interacting with her baby.

The children’s cognitive ability was assessed by IQ tests administered by the children’s pediatricians and by their teachers’ ratings of their academic performance in reading, writing, mathematics and other subjects. Both sets of measures were significantly higher in the group randomized to the breastfeeding promotion intervention.

"The effect of breastfeeding on brain development and intelligence has long been a popular and hotly debated topic,” says Dr. Kramer. "While most studies have been based on association, however, we can now make a causal inference between breastfeeding and intelligence – because of the randomized design of our study.”