BABY FAT NOT SO EASY TO LOSE

Obesity among children in the United States has skyrocketed to epidemic levels over the past 30 years. Rapid weight gain during the first weeks or months of infancy predicts obesity and high blood pressure later in childhood and adulthood. In “Weight Status in the First 6 Months of Life and Obesity at 3 Years of Age,” researchers studied 559 children in Project Viva, an ongoing cohort study of pregnant women and their babies. Each child was measured by weight and length at birth, 6 months and 3 years. Results, which did not vary according to gender, indicate that rapid gains in weight-for-length in the first 6 months were associated with a significant risk of obesity at 3 years of age. This suggests that changes in weight status in infancy, rather than weight status at birth, may determine risk of obesity later in childhood. Given the increasing prevalence of childhood obesity and the growing evidence that preventative efforts beginning in infancy may help avoid weight problems in the future, the study authors suggest health professionals should consider formulating new policies and interventions to reduce rapid infant weight gain.

WATER FOUNTAINS IN SCHOOLS CAN PREVENT OVERWEIGHT

Providing filtered water fountains and water bottles to schoolchildren can lower their risk of being overweight, according to the study, “Promotion and Provision of Drinking Water in Schools for Overweight Prevention: Randomized, Controlled Cluster Trial.” Researchers studied second- and third-graders from 32 elementary schools in socially deprived areas of two German cities. Water fountains were installed and teachers taught four classroom lessons on water consumption in 17 of the schools; the other schools received no intervention. After one school year, the risk of overweight was reduced by 31 percent in the intervention group compared to the control group. Children in the schools with the water fountains drank about 1.1 more glasses of water per day. Researchers also found water use increased when children received new water bottles.

INFANTS BORN ONE TO THREE WEEKS EARLY AT RISK OF DEVELOPMENTAL DELAY

Until recently, infants born one to three weeks early – called “late preterm” – have received little attention because of assumptions that they had little risk of long-term problems. But a new study shows that those last weeks in the womb, when dramatic brain maturation and growth occur, are associated with the child’s future development and success in school. In “Early School-Age Outcomes of Late Preterm Infants,” researchers found healthy children born at 34 to 36 weeks’ gestation had a 36 percent higher risk of developmental delay or disability through the first five years of life compared with healthy term infants (born at 37 to 41 weeks’ gestation). Researchers found late preterm infants were more likely to be suspended in kindergarten or held back in kindergarten. These infants represent a significant portion of preterm deliveries in the U.S. It has been estimated that 70 percent of preterm births are born at 34 to 36 weeks’ gestation. In addition, births at 34 to 36 weeks’ gestation increased 25 percent between 1990 and 2005, whereas births at less than 34 weeks’ gestation remained unchanged. The study authors suggest obstetricians should consider the risk for developmental delay when weighing the risks and benefits of late preterm delivery. These children need close developmental follow-up, and parents and physicians should be aware of the risks for school underachievement and behavioral problems so they can get prompt referrals to early intervention services if needed.

SLEEP-DEPRIVED KIDS MORE LIKELY TO HAVE PROBLEMS AS TEENAGERS

Sleep problems during childhood may be associated with neuropsychological performance during adolescence. In the study, “Sleep Problems in Childhood Predict Neuropsychological Functioning in Adolescence,” parents reported on their children’s sleep problems at 5, 7 and 9 years of age. Neuropsychological functioning was assessed through testing when the participants were 13 years of age. Data from 720 participants were analyzed and results indicate that children reported to have sleep issues such as difficulties initiating and maintaining sleep may have slightly poorer functioning on certain tasks in adolescence. These tasks tap skills including complex visual scanning. Sleep disturbance in childhood was not associated with many other areas of performance (e.g. verbal fluency). This preliminary research needs replication, but emphasizes the need to invest in and increase understanding of the links between sleep problems and neuropsychological functioning in youth.

NEW MOMS OF MULTIPLES MORE LIKELY TO BE DEPRESSED

Mothers of multiples are 43 percent more likely than mothers of single babies to have moderate to severe depression nine months after the births, according to the study “Multiple Births Are a Risk Factor for Postpartum Maternal Depressive Symptoms.” The study looked at a nationally representative sample of more than 7,000 mothers of singletons and 776 mothers of multiples. Of both groups of mothers, only 27 percent of those who had moderate to severe depressive symptoms reported talking about it with a mental health specialist or general medical care provider. The authors note that undergoing a high-risk pregnancy and delivering multiple babies are stressful life events, and the unique demands of caring for multiples, including fatigue and social isolation, can contribute to parental stress and depression. The authors concluded that greater attention is needed in pediatric settings to address maternal depression in families with multiple births.

Editor’s Note: The April issue includes another article on postpartum depression: “The Relationship Between Infant-Feeding Outcomes and Postpartum Depression: A Qualitative Systematic Review.

SMOKING IN MOVIES CAN CREATE A LONG-TERM HABIT

Exposure to smoking in movies has been shown to increase the likelihood that teens will at least try smoking. A new study, “Early Exposure to Movie Smoking Predicts Established Smoking by Older Teens and Young Adults,” shows that smoking in movies may have an even bigger impact: development of established smoking habits. The authors followed more than 1,700 pre-teens for almost seven years and found that those with the highest level of movie smoking exposure were twice as likely to become established smokers. Established smokers were defined as those having smoked more than 100 cigarettes. The authors conclude that high exposure to movie smoking at a young age not only contributes to smoking initiation, but may also promote progression to more advanced smoking behaviors.

HOUSEHOLD COMPOSITION IMPACTS CHILDREN’S EXPOSURE TO SECONDHAND SMOKE

Public smoking bans have led to the protection of large numbers of adults from secondhand smoke. However, children have not benefited as much from these laws since most children are exposed to secondhand smoke in their homes. Thirty-four percent of U.S. children live in homes with at least one adult smoker. The study, “Family Composition and Children’s Exposure to Adults Smokers in Their Homes,” found that whether or not a child lives with an adult smoker varies significantly depending on the household composition. Children in lower income households were more likely to live with a smoking adult. Children below the federal poverty line were twice as likely to live with one adult smoker, and three times more likely to live with two or more smokers. The same is true for children living with an adult who is not their parent. And 17 percent of children who live with a non-smoking mother still had a smoking adult in the home. The authors state that the study shows that household poverty and increasing numbers of adults in the home increase the likelihood that children are living with adult smokers and are exposed to secondhand smoke.

RETHINKING SUDDEN UNEXPECTED CARDIAC DEATHS IN ATHLETES

Hypertrophic cardiomyopathy (HCM), a thickened heart muscle that makes it harder for the heart to pump blood, has traditionally been considered a major cause of sudden unexpected cardiac death in young athletes. Under the commonly accepted scenario, a young person with pre-existing, unsuspected HCM suffers sudden death as a result of the stress imposed on the heart by sports training. These deaths are extremely rare (1 in 400,000 athletes). Preventive efforts involve using medical screening to detect the athlete with pre-existing disease. However, according to the review article, “Sudden Unexpected Death in Young Athletes: Reconsidering ‘Hypertrophic Cardiomyopathy,’” HCM might not be the true cause of these deaths. Based on certain epidemiological evidence, some of these deaths may not be related to a disease, but rather to heart muscle thickening due to sports training itself. Athletes most at risk include black males. If the author’s conclusions are correct, prevention efforts would require a different strategy to identify the would-be athlete who is predisposed to exaggerated growth of the heart muscle in response to training.

BETTER ACCESS TO MENTAL HEALTH SERVICES BEGINS WITH REDUCING FINANCIAL BARRIERS

The American Academy of Pediatrics (AAP) and the American Academy of Child and Adolescent Psychiatry (AACAP) have developed a joint position paper in an effort to ensure the mental health and wellness of children and adolescents. In “Improving Mental Health Services in Primary Care: Reducing Administrative and Financial Barriers to Access and Collaboration,” the authors examine results from a Surgeon General report stating that one in five children in the United States suffers from a diagnosable mental disorder, but only 20 percent to 25 percent of affected children receive treatment. By addressing the financial and administrative barriers that primary care physicians face in providing behavioral and mental health services, the authors hope to improve access and treat childhood mental illness and its many detrimental consequences.

EDITOR’S NOTE: Two additional studies focusing on mental health disorders also appear in the April issue: “Screening for Child and Adolescent Depression in Primary Care Settings: A Systematic Evidence Review for the US Preventive Services Task Force,” and “Screening and Treatment for Major Depressive Disorder in Children and Adolescents: US Preventive Services Task Force Recommendation Statement.”