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Hello, and welcome to Parenting News Online! I originally started this website in order to bring you, a parent, newsworthy articles about parenting, health, nutrition, and coping skills. What it has morphed into is a collection of articles based on new medical research related to kids. And I hope you enjoy paging through the articles as much as I enjoy writing them.

But I do need some help from you. I would ask you to submit ideas for topics on the form below. Otherwise I’ll just keep writing about whatever tickles my fancy. And that’s not really the point. Please take a second and tell me what you want to know, and I’ll do my best to bring it to you.

And thank you again for coming!

Ed





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Biomarkers of second-hand smoke in infants

This notice doesn't like passive smoking

This notice doesn’t like passive smoking (Photo credit: James Cridland)

We can all agree that second-hand smoke is not good for the tender lungs of children. It is associated with respiratory ailments in kids like asthma, bronchitis, and pneumonia, not to mention the modeling of behaviors that kids learn by watching their parents smoke. Physicians are not always good at asking about smoking around the children unless the child comes in for repeated lung infections. Also parents may not be aware of exposures their kids might encounter outside of the home.


 

In this study, researchers tested the plasma samples of almost 500 infants and children being tested routinely for lead levels in county health care centers in San Francisco, CA. The test measured plasma cotinine, a metabolite of nicotine that is associated with second-hand smoke. These blood test results were compared to their medical records to see how effectively the health care team was screening for second-hand smoke exposure by history. Their results showed that while thirteen percent of parents reported that their child was exposed to second-hand smoke, biochemical testing detected cotinine in 55% of samples. There were no significant sex or age differences.

In a city with a low smoking rate (12%) and public smoking bans, this study documented 55% exposure among infants and young children using a plasma biomarker, compared with 13% exposure reported by parents. Because SHS is associated with significant respiratory diseases and parents underreport exposure, these scientists recommend mandatory routine biochemical screening as a tool to identify and reduce second-hand smoke exposure. This is a very interesting, novel approach to try to reduce smoking near, and eventually smoking by, our children. –ER

 

Reference: Dempsey DA, et al. Determination of Tobacco Smoke Exposure by Plasma Cotinine Levels in Infants and Children Attending Urban Public Hospital. Arch Pediatr Adolesc Med. 2012;():1-6. doi:10.1001/archpediatrics.2012.170

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Use of probiotics in acute diarrhea in kids

Probiotics are commonly used to treat acute diarrheal illnesses in children and adults. Diarrhea is a disease of global concern, since it is one of the leading causes of death in children world-wide. Typical treatment currently consists of rehydration (giving extra fluids), nutritional support, zinc supplementation, selective antibiotic use, and parental education. Previous studies have shown that probiotics can help dramatically in the treatment of diarrhea, probably by restoring the normal bacterial make-up of the colon and improving digestion. A fear raised about probiotics is that they are in fact live bacterial cultures, and in a susceptible patient could cause systemic infections.

 



This study looked at the effects of adding a specialized type of probiotic called tyndallized (or killed) probiotics to see if they would accomplish the same thing. The hope was that it was the immune response caused by the presence of the bacteria, be they live or killed, that would help with the diarrhea. That turned out not to be the case, since the tyndallized probiotic treatment group did not improve faster than the group who did not receive these killed probiotics.

The message for parents is to use live probiotics when children get gastroenteritis or stomach flu. The risk of overwhelming infection is low, and the killed probiotics are a waste of money.

Reference: Fanny KM, et al. Effect of adding tyndallized probiotics to the World Health Organization standard therapy for acute diarrhea in children. Paediatr Indones, Vol. 52, No. 2, March 2012.


 

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Duration for exclusive breastfeeding

A baby having milk from a bottle.

A baby having milk from a bottle. (Photo credit: Wikipedia)

The discussions about “attachment parenting” have reignited several questions about how long mothers should nurse their babies and whether or not to introduce other foods at an age less than 6 months. The World Health Organization has recommended exclusive breastfeeding for the first 6 months of life, and the United States Surgeon General recently issued a “call to action” to lawmakers and the health care community to develop systems that allow women to breastfeed more easily. Some organizations have advocated breastfeeding into the toddler years in addition to regular food. With all of this discussion, one might wonder if it is wrong to start adding other foods earlier than 6 months. There is always the fear that the nutritional support provided by exclusive breast feeding will be adequate up to the age of 6 months.




In this project, researchers studied 100 infants who were enrolled into the study at age 4 months. At that time, half of the infants were assigned to a breastfed- only group, and the other half were enrolled in the breastfed plus other foods group. They utilized advanced measurement techniques to see how much each group consumed in terms of breast milk and other foods. Turns out that the babies that were assigned to the breast milk plus other foods consumed less breast milk, but that weight gain and overall growth was the same between groups.

The final conclusion was that breastfeeding alone provided adequate calories and overall nutrition to support growth. Other foods weren’t necessary. One could also argue that those kids who received a portion of their nutrition from outside sources probably missed out on some of the vast amounts of benefits derived from breast milk, like antibodies, iron, and immune system peptides.

 

Reference: Wells JCK, et al. “Randomized controlled trial of 4 compared with 6 mo of exclusive breastfeeding in Iceland: differences in breast-milk intake by stable-isotope probe.: Am J Clin Nutr 2012; May 16.

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Wealth, race, and the diabetes insulin pump

English: mbbradford, i made this image myself

English: mbbradford, i made this image myself (Photo credit: Wikipedia)

Today the perceived “Gold Standard” of care for Type I Diabetes Mellitus (T1DM) is the insulin pump. Early implantation of the pump is associated with better outcomes for the child. Yet not every child with T1DM receives one. This study looked at differences based on race and socioeconomic status. Not surprisingly, wealthy white kids were more likely to receive a pump. Of concern is that the decision to implant a pump did not seem to depend on how bad the diabetes control was.

 



Every healthcare system in the world has its strengths and faults. A common complaint about healthcare in the US is that some people consistently get better care than other people, presumably because of economic factors or access to care. Even in systems with nationalized health care, most people get the government-supplied care while wealthier people get “better” care. I’m not sure how the Affordable Care Act will influence this dilemma. Until then, it helps to take a look at biases inherent in our current system and work to eliminate them.

Reference:

Maria H. Lin, Crystal G. Connor, Katrina J. Ruedy, Roy W. Beck, Craig Kollman, Bruce Buckingham, Maria J. Redondo, Desmond Schatz, Heidi Haro, Joyce M. Lee, William V. Tamborlane, and Jamie R. Wood, for the Pediatric Diabetes Consortium. Diabetes Technology & Therapeutics. November 2013, 15(11): 929-934. doi:10.1089/dia.2013.0132.


 

 

Nutritional supplements for human milk donors

Foremilk and Hindmilk samples of human breast milk

Foremilk and Hindmilk samples of human breast milk

Human milk banks have been around since the mid-1980s, storing and distributing human milk donated by women with the sole intent of increasing the availability of human milk and all of its immunologic and nutritional goodies especially for fragile newborns. This study looked at supplementing the “supplementors” with a long-chain fatty acid called DHA that is important for brain development and healthy immune systems in infants. Babies that are born prematurely may be looking at requiring banked human milk for prolonged periods of time, and the amounts of this important fatty acid tend to be too low in human milk. So researchers gave these women supplements to increase the concentration DHA in their milk. The study found that the amount of DHA given to these infants was equivalent to what they would have received in the uterus had the pregnancy gone on longer.




The next question will be whether or not this makes any differences to the infants. But I was so impressed by the idea that there was such a thing as milk banks. And they have been around for at least 25 years. And that I had never heard of them. Women interested in donating can contact Human Milk Banking Association of North America (HMBANA) through their website. — ER

Reference: Valentine CJ et al, “Randomized Controlled Trial of Docosahexaenoic Acid Supplementation in Midwestern U.S. Human Milk Donors”. Breastfeed Med. 2012 May 8.


 

Breast Milk Immune Properties

A baby having milk from a bottle.

A baby having milk from a bottle. (Photo credit: Wikipedia)

Not all breast milk is created equally. It has been shown that there are wide variations in the amounts of fat, glucose, vitamins, and minerals in breast milk, not only from person to person but even within the same person on the same day. Some of the nutritional characteristics of breast milk are influenced by the mom’s state of nutrition, medications, hydration, and vitamin supplements.




The present study evaluated the immune properties of breast milk in response to certain dietary interventions. Breast milk contains fatty acids with “immunomodulatory properties”, which means that they can either strengthen or weaken the baby’s immune system. Sometimes weakening the immune system can be a good thing within certain limits, such as when a person is having an allergic reaction or some kind of autoimmune disease like lupus. Breast milk is once again almost the perfect food.

Pregnant women were divided up into three study groups: dietary intervention with probiotics (diet/probiotic) or with placebo (diet/placebo) and a control group (control/placebo). Dietary intervention included dietary counseling and provision of rapeseed (canola) oil-based food products. The probiotics used were Lactobacillus and Bifidobacterium in combination. Dietary intake was evaluated by food records at intervals during the pregnancy and 1 month postpartum. Breast milk samples were collected after birth (colostrum) and 1 month after delivery. A total of 125 women participated.

Dietary intervention (adding the canola-based foods) improved the quality of fat in the diet. In breast milk, the proportion of several fatty acids and other peptides useful in controlling immunity increased (including α-linolenic acid, n-3 fatty acids, γ-linolenic acid, TNF-α, IL-10, IL-4, IL-2 and long-chain n-3 fatty acids). This shows that the immune properties of breast milk can be improved by dietary interventions such as increasing the amount of canola oil taken in by the pregnant and lactating woman.

Because of its light flavor and smooth texture, canola oil is one of the most versatile cooking oils. You can use it in a number of dishes and cooking methods. Here are a few ideas for cooking with canola oil:

  • Use as a cooking oil for sauteing, stir-frying, grilling, and baking.
  • Add it to salad dressings, sauces, and marinades.
  • Use it to coat your pans for nonstick baking.
  • Replace it for solid fats (such as margarine and butter) in recipes.

Reference: Hoppu U, et al, “Probiotics and dietary counselling targeting maternal dietary fat intake modifies breast milk fatty acids and cytokines”, European Journal of Nutrition, Volume 51, Number 2 (2012), 211-219.


 

 

Tourette syndrome and associated conditions

Splashes approximating big

(Photo credit: normalityrelief)

This is a new area of interest for me, and since it’s my website and I’m about the only one to read these articles, I get to pick! Tourette syndrome is a neurologic or neuropsychiatric disorder characterized by tics, both muscular and spoken, that starts during childhood. Once considered rare, it is now recognized to be frequently missed. As many as 4% of school-aged kids demonstrate some component of Tourette’s syndrome, but the majority of these tics resolve or are easily controlled by adulthood.


Interestingly, Tourette syndrome often accompanies other psychological issues such as obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD). It is often these other conditions that are more of a long-term problem for the patient. This study looked at 158 kids with chronic tic disorder (Tourette’s syndrome) to see if these other conditions were related to the severity of the tics. They found that over half of children with Tourette syndrome also had OCD, over a third had ADHD, and a quarter had both. There were differences in severity of the tic disorder depending on the presence or absence of OCD or ADHD. Kids with OCD had worse tics, worse depression and anxiety, worse stress levels, and worse overall functioning. Patients who had ADHD did not have worse tics, but did have worse stress levels and worse overall functioning. They also had more symptoms of oppositional defiant disorder.

It’s interesting to speculate that these conditions and others may have common causes and common pathways. That leads to hope that if and when we find a cure for one, we will have the cure for all of them.


 

Reference:

Lebowitz ER, et al. “Tourette syndrome in youth with and without obsessive compulsive disorder and attention deficit hyperactivity disorder.” European Child & Adolescent Psychiatry 2012, DOI: 10.1007/s00787-012-0278-5.


 

 

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