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

For Release: November 5, 2007, 12:01 am (ET)

ANTIREFLUX MEDICATION MAY BE OVERPRESCRIBED IN INFANTS

A majority of infants taking antireflux drugs did not meet the diagnostic criteria for gastroesophageal reflux disease (GERD), according to a new study, "Are We Overprescribing Antireflux Medications for Infants With Regurgitation?" Researchers conducted esophageal pH monitoring (measuring the reflux or regurgitation of acid from the stomach into the esophagus) of 44 infants in a New Orleans medical center. Each of the children had persistent regurgitation and was referred to a specialty service for further management. The study showed that while only eight of the infants had abnormal pH levels indicating GERD, 42 of 44 infants were on antireflux medication. When medication was withdrawn from the infants who did not meet GERD criteria, reflux symptoms did not worsen. The study authors concluded that antireflux medications were unnecessary in the majority of infants who were prescribed such medication.

EARLY VIOLENT TELEVISION VIEWING ASSOCIATED WITH LATER ANTI-SOCIAL BEHAVIOR

A new study links violent television viewing by preschool boys (ages 2 to 5) with antisocial behavior at ages 7 to 9. In "Violent Television Viewing During Preschool Associated With Anti-social Behavior During School Age," researchers reviewed data from the Panel Study of Income Dynamics (a nearly 40-year study of 8,000 U.S. families) on 184 boys and 146 girls on violent television viewing between ages 2 and 5 for children, and anti-social behavior between ages 7 and 10. The data review found a link between pre-school-age boys watching violent programming and antisocial behavior at ages 7 to 9. There was no link found between non-violent television viewing and antisocial behavior in boys or girls, or violent programming and anti-social behavior in girls. The study authors say the findings are significant as early childhood aggressive behavior is often a predictor of violent behavior in youth and adolescents.

[EDITOR'S NOTE: A related study, "Associations Between Content Types of Early Media Exposure and Subsequent Attention Problems," found that the association between early television viewing and subsequent attentional problems is specific to noneducational viewing and to viewing before age 3. ]

TOO LITTLE SLEEP LINKED WITH OBESITY IN YOUTH, AGES 9 TO 12

In a new study, children who got less sleep in 3rd and 6th grades were more likely to be overweight in 6th grade. Researchers in "Shorter Sleep Duration Is Associated With Increased Risk for Being Overweight at Ages 9 to 12 Years," reviewed data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development on reported sleep problems, sleep duration and Body Mass Index (BMI). Sixth graders with shorter nightly sleep durations (fewer than nine hours) were more likely to become overweight by 6th grade. And 3rd grade students who got less sleep, regardless of their BMI at the time, also were more likely to become overweight in 6th grade. For every additional one hour of sleep in 6th grade, a child was 20 percent less likely to be overweight in 6th grade; every additional hour of sleep in 3rd grade resulted in a 40 percent decrease in the child's risk of being overweight in 6th grade. As ensuring adequate sleep may prevent obesity, the study authors recommend that pediatricians discuss appropriate bedtimes with parents, and that schools consider later start times.

CORRELATION BETWEEN HIGHER OUT-OF-POCKET IMMUNIZATION COSTS AND LOWER VACCINATION RATES

Low-income, uninsured families who pay high out-of-pocket expenses for immunizations are more likely to have under immunized children, according to a new study. In "Out-of-Pocket Costs of Childhood Immunizations: A Comparison by Type of Insurance Plan," researchers reviewed 2003 benefit plan data for 1,217 private and public health plans in Georgia to assess immunization rates per child, based on insurance status and income. The data showed that out-of-pocket immunization costs ranged from $0 for Medicaid and Peachcare for Kids (Georgia's State Child Health Insurance (SCHIP) program) recipients, to $652 for uninsured and Medicare families. Most out-of-pocket costs were incurred during the first year of life. Up-to-date immunization status ranged from 63.7 percent for uninsured patients to 83.2 percent for privately insured patients. Families living at 250 percent of the federal poverty level or below were the least likely to be fully immunized. The study authors recommend that immunization coverage through the Vaccines for Children Program, Medicaid and SCHIP programs be better promoted to minimize or eliminate out-of-pocket immunization costs.

DESPITE DIFFERENT HEALTH CARE SYSTEMS, ENGLAND AND U.S. SHARE COMPARABLE MINORITY LOW INFANT BIRTH WEIGHT RATES

Despite universal health care, low infant birth weight rates for minority children in England are as high as those in the U.S. In "A Cross-National Comparison of Racial and Ethnic Disparities in Low Birth Weight in the United States and England," researchers reviewed risk factors and rates of low birth weight from the Early Childhood Longitudinal Study-Birth Cohort in the U.S., and the New Millennium Cohort Study in England. For single births in the U.S., the rate of low birth weight among black mothers was 10.3%, twice that of white mothers at 4.6%. For Hispanics the rate was 5.6 percent; for Asian mothers, 6.4 percent; and American Indians, 5.7 percent. In England, the low-birth weight rate among black mothers also was nearly twice that of white mothers (9.4 percent versus 5.4 percent), and the rate among Asian mothers, 11.5 percent. Among the risk factors for low-weight birth in the U.S., non-Hispanic black, Hispanic and American Indian mothers were more likely to give birth at a younger age. In England, teen birth rates were similar for black and white mothers. The study authors conclude that despite differences in public health systems and immigration history, racial and ethnic disparities in infant low birth weight are comparable in England and the U.S.

LOWER BLOOD LEAD LEVELS WARRANT ACTION

Even blood lead levels (BLLs) below 10 *g/dL can adversely affect a child's physical and mental development, according to the special article, "Interpreting and Managing Blood Lead Levels of less than 10 *g/dL in Children and Reducing Childhood Exposure to Lead: Recommendations of the Centers for Disease Control and Prevention Advisory Committee on Childhood Lead Poisoning Prevention." In 1991, the US Centers for Disease Control and Prevention defined a BLL of 10 *g/dL or greater as the point for health action, while recognizing that the level did not define a threshold for the harmful effects of lead. Since then, additional studies have outlined health risks associated with lower BLLs. The article provides information to help physicians and government agencies to understand lower BLLs, identify gaps in knowledge concerning these levels, and outline strategies to reduce child exposure to lead. The article recommends that clinicians provide information to all parents of young children regarding the dangers and sources of lead exposure, assess individual child risk, and choose laboratories that can achieve routine BLL results within ±2 *g/dL. The article also recommends that government agencies increase efforts to resolve lead-based paint hazards before children are exposed, expand services that promote lead poisoning prevention, and encourage more laws and research pertaining to lead hazards.

AAP UPDATES CONTRACEPTION, ADOLESCENT SEXUAL BEHAVIOR INFORMATION FOR PEDIATRICIANS

In a revised policy statement, the AAP provides pediatricians with updated information on adolescent sexual behavior and guidelines for counseling patients about available contraception. The policy statement, "Contraception and Adolescents," reiterates the AAP's recommendation that adolescents postpone consensual sexual activity until they are fully ready for the emotional, physical and financial consequences of sex. However, for youth who choose to have sex, pediatricians have a responsibility to provide confidential, non-judgmental education and risk-reduction counseling on sexual issues and/or contraception needs, according to the policy statement. Pediatricians should regularly update their patient's history to determine risk for pregnancy and Sexually Transmitted Infections (STIs). Counseling should include the need for contraception initiation and management, including consistent condom use during sexual intercourse. Comprehensive information on availability and success of emergency contraception and newer forms of contraception are fully outlined in the policy statement.

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.