Below are news releases and briefs on statements appearing in the April ssue of Pediatrics, the peer-reviewed, scientific journal of the American Academy of Pediatrics (AAP).

For Release: April 7, 2008, 12:01 am (ET)

CHILDHOOD AUTISM LINKED TO SUBSTANTIAL LOSS OF HOUSEHOLD INCOME
Families of children with autism incur substantial out-of-pocket costs for educational, behavioral and health care services. A new study in the journal Pediatrics found autism also has an impact on the income side of the family economy. The study, "Association of Childhood Autism Spectrum Disorders and Loss of Family Income," drew on the results of a 2005 national survey of 11,684 households with children enrolled in kindergarten to eighth grade. The sample included 131 children with autism spectrum disorders (ASD) and 2,775 children with other disabilities. Researchers found both having a child with ASD and having a child with other disabilities were associated with lower household income regardless of parental education, family structure, parental age, rural or urban location or minority ethnicity. The average loss of annual income associated with having a child with ASD was $6,200 or 14 percent of a family's annual reported income. The authors speculate the most likely explanation is that parents of a child with ASD make different working choices, such as working part-time, because of the needs associated with autism and the lack of community-based resources.

PREMATURE BIRTH MAY BE ASSOCIATED WITH HIGHER LIKELIHOOD OF AUTISM
Advances in neonatal intensive care have dramatically improved the survival of premature infants, resulting in a growing population of survivors at risk for prematurity-related complications. A significant number of these children display neurodevelopmental impairment by school age. The Pediatrics study, "Positive Screening for Autism in Ex-preterm Infants: Prevalence and Risk Factors," is the first to document a high prevalence of early autistic features in survivors of extreme prematurity using a validated autism screening test. Researchers performed standard developmental tests in 91 children between the ages of 18 and 24 months who had been born prematurely (median gestational age of 26 weeks). Of the 91 children, 23 (or 25 percent), had positive results on an autism screening test. Lower birth weight and gestational age, male gender, prenatal infection, greater illness acuity and abnormal MRI studies were risk factors for a positive autism screen. The findings require corroboration in larger prospective studies, but the data suggest the unusual social and behavioral features noted in ex-preterm infants may represent the early warning signs of Autism Spectrum Disorder.

SCHOOL-BASED PROGRAM HELPS PREVENT OBESITY
As children spend half their waking hours in school, the school setting can be an ideal forum to educate students about healthy food choices. A study in the journal Pediatrics found a nutrition program that originates in the community can be effective in preventing overweight. The study, "A Policy-Based School Intervention to Prevent Overweight and Obesity," followed 1,349 students in grades 4 through 6 in 10 schools in Philadelphia for two years. At least 50 percent of the students were eligible for free or reduced-price meals. In half the schools, school health teams replaced unhealthy snacks and beverages with healthier options, developed strategies to promote healthy eating, trained school staff in nutrition education and provided 50 hours of nutrition education to each student per year. The intervention schools also offered prizes to students who ate healthy snacks and beverages and encouraged parents to purchase healthy snacks and limit sweets. After two years, significantly fewer children in the intervention schools (7.5 percent) than in the control schools (14.9 percent) became overweight. The program was particularly effective for black students in the intervention schools, who were 41 percent less likely to be overweight than black students in the control schools. Because there was still a 7.5 increase in overweight in the intervention schools, the study authors suggest a need for additional interventions, such as increased physical education.

TEENS WITH A TV IN THEIR BEDROOM HAVE FEWER HEALTHY HABITS
Older adolescents who have a television where they sleep are less likely to engage in healthy activities such as exercising, eating fresh vegetables and enjoying family meals, according to the study "Characteristics Associated With Older Adolescents Who Have a Television in Their Bedrooms." A study group of 781 socioeconomically and ethnically diverse teens participating in the Project EAT study reported on their television viewing habits, study habits and grades, diet, exercise habits and "family connectedness." About two-thirds of the teens, who had a mean age of 17.2 years, had a television in their bedroom or sleeping area. They watched four to five hours more television each week. Girls with a TV in their bedrooms spent less time in vigorous activity each week than girls without TVs in their rooms (1.8 vs. 2.5 hours). They also ate fewer fresh vegetables (1.7 vs. 2.0 servings per day), and had fewer family meals (2.9 vs. 3.7 meals per week). Boys with TVs in their rooms not only had lower fruit intake and fewer family meals, they also had a lower grade point average compared to their counterparts with no TVs in the bedroom (2.6 vs. 2.9). Overall, teens with televisions in their rooms ate more fast food, consumed more sweetened beverages and read or studied less. The authors from the University of Minnesota conclude that refraining from placing a television in teenagers' rooms may be a first step in helping to reduce screen time and subsequent poor behaviors associated with TV watching.

EARLY CHILD NEGLECT CAN LEAD TO AGGRESSIVE BEHAVIOR YEARS LATER
Child neglect may have the most profound effect on development of aggression if it occurs before age 2, according to the study "Importance of Early Neglect for Childhood Aggression." Researchers interviewed more than 1,300 at-risk children at ages 4, 6 and 8. Sixty percent of the children had been exposed to abuse, neglect or both before age 4. The children's caregivers rated their aggressive behaviors according to a scale that included fighting, threatening others, destroying property and cruelty. Researchers found that physical neglect reported to child protective services before age 2 was a stronger predictor of later aggression than either neglect at older ages or abuse at any age. The authors conclude that solving the problem of early neglect has the potential for immediate, intermediate and long-term benefits in reducing youth violence.

GYMNASTIC-RELATED INJURIES TO CHILDREN IN THE UNITED STATES
More than 600,000 U.S. children take part in school-sponsored and club-level gymnastics competitions each year. Gymnastics is commonly overlooked in terms of the possibility of injury, yet has one of the highest injury rates of all girls' sports. The study, "Gymnastics-related Injuries to Children Treated in Emergency Departments in the United States, 1990-2005," examined data on children 6 to 17 years of age who were treated in hospital emergency departments for gymnastics-related injuries. On average, 26,600 injuries were reported annually. The majority of injuries (40 percent) occurred at school or at a place of recreation or sports. Girls were more likely than boys to sustain upper extremity injuries, while head and neck injuries were more common in boys. Fractures and dislocations were most common for children 6 to 11 years of age, and strains and sprains were more frequent in the 12 to 17 age group. The authors suggest injury-prevention strategies including enforcement of universal rules and regulations for gymnasts, spotters and coaches.

SPORTS PARTICIPATION AND MEDICAL CONDITIONS
Children and adolescents with medical conditions need to be evaluated before participating in athletic activities. As a result, pediatricians play an important role in determining whether a child with a medical condition should participate in a particular sport. In the revised American Academy of Pediatrics (AAP) clinical report, "Medical Conditions Affecting Sports Participation," current evidence supports and encourages children with medical conditions to participate in most athletic activities. The report, which replaces a 2001 policy statement, includes a detailed list of medical conditions and describes how health care professionals should assess a child's health status, suggest appropriate equipment or modifications to decrease the risk of injury, and educate the athlete, parent(s) and coach on potential dangers of participation and associated training activities.

UNDERSTANDING UNDERAGE DRINKING
Alcohol is the most widely used substance of abuse among young people in the U.S., with serious economic, social and personal costs. Consequences of underage alcohol use include death by alcohol poisoning, risky sexual behavior, physical and sexual assaults, injuries, suicide, academic failure and automobile accidents associated with drunk driving. Long-term, adolescents who engage in binge drinking are more vulnerable to developing full-blown alcohol dependence in the future. Addressing underage drinking most effectively requires an understanding of the complex interplay of developmental and environmental factors during childhood and adolescence. In a supplement to the April issue of Pediatrics, a collection of seven papers examines alcohol use in young people, early predictors of alcohol use and abuse, and treatment and prevention, all in a developmental framework.

CARING FOR INJURED CHILDREN
Trauma is the No. 1 cause of death and disability killer for children in the United States. Each year an estimated one in four children sustains an unintentional injury that requires medical care. Therefore, it is important that pre-hospital and hospital-based care providers are trained to meet the unique medical needs of injured children in trauma. The AAP has issued a new policy statement, "Management of Pediatric Trauma," that offers guidance on creating an optimal system to care for injured children. It states that the needs of children should be integrated into the emergency and disaster planning of every state and region. Every pediatrician and emergency care professional credentialing and certification body should require practitioners to receive appropriate levels of initial and continuing education to achieve and maintain competency in caring for critically injured children of all ages. The statement also stresses the importance of ongoing injury prevention education.

STRENGTH TRAINING OK FOR TEENS
Young athletes may consider strength training to improve their athletic performance. Strength training involves using weights or resistance to build muscle strength. The AAP has issued a revised policy statement, "Strength Training by Children and Adolescents: Guidance for the Clinician in Rendering Pediatric Care," to help pediatricians ensure that strength training benefits the athlete, rather than causes injury or pain. The AAP recommends that before an athlete begins a formal strength-training program, a medical exam should be performed. Even then, preteens and teens should avoid power lifting and body building until they reach skeletal maturity. Any strength training session should involve a warm-up and cool-down period. To reap the greatest health benefits, aerobic conditioning should be coupled with resistance training. It's also important that proper techniques be taught and practiced before adding resistance or weight load to any exercise. Lastly, the AAP stresses that athletes should be warned against using performance-enhancing substances and educated on the dangers of doing so.

ANNUAL SUMMARY OF VITAL STATISTICS: 2006
The "Annual Summary of Vital Statistics: 2006," the yearly report of births, fertility rates and causes of death, revealed some surprising results. Births in the United States increased 3 percent between 2005 and 2006, the largest increase since 1961. Birth and birth rates increased among all race and Hispanic origin groups. Teen childbearing rose 3 percent among females aged 15 to 19 years, the first increase after 14 years of steady decline. Childbearing by unmarried women rose steeply and set a historic new high at 1.64 million births, 8 percent higher than the previous year. The cesarean-delivery rate rose by 3 percent; this figure has been up 50 percent over the past decade. Black newborns continued to be more than twice as likely as non-Hispanic white and Hispanic infants to die in the first year of life. As in past years, a large number of childhood deaths continue to occur as a result of preventable injuries. For all children aged 1 to 19 years, accidents and assaults were the first and second leading causes of death. Overall, life expectancy reached a record high of 77.9 years.

SCHOOL READINESS IS A JOINT CONCERN
In 1991, the U.S. set a goal to have all children enter school "ready to learn" by 2000. Yet it is schools' responsibility to be prepared for children at all levels of readiness, according to a new technical report, "School Readiness," by the AAP. Rather than using school readiness tests as a basis for excluding children from school, these tests should become an outcome measure for community-based programs designed to improve children's early experience and prepare them for school. Pediatricians can promote school readiness by identifying children with developmental delays, guiding families to services, and advocating for services in the community that promote early brain and child development. Investing in early childhood and young families is the most efficient strategy for strengthening America's future students and future workforce.

The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well being of infants, children, adolescents and young adults.