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

For Release: October 1, 2007, 12:01 am (ET)

CONSISTENT, FREQUENT TV VIEWING CAUSES BEHAVIOR PROBLEMS

Consistent, heavy television viewing (more than two hours a day) throughout early childhood can cause behavior, sleep and attention problems. In the new study, "Children's Television Exposure and Behavioral and Social Outcomes at 5.5 Years: Does Timing of Exposure Matter?" researchers assessed data from the Healthy Steps for Young Children national evaluation effort pertaining to the effects of early, concurrent and sustained television exposure at age 2.5 years, and again at age 5.5 years. The effects of having a television in the child's bedroom were measured at age 5.5. Sixteen percent of parents reported
that their child watched television more than two hours a day at age 2.5 years only (early exposure), 15 percent reported that their children watched more than two hours of television daily at 5.5 years only (concurrent exposure), and 20 percent reported more than two hours of television viewing daily at both times (sustained exposure). Forty-one percent of children had a television in their bedroom at age 5.5. Sustained television viewing was associated with sleep, attention and aggressive behavior problems, and externalizing of problem behaviors. Concurrent television exposure was associated with fewer social skills. Having a television in the bedroom was associated with sleep problems and less emotional reactivity at age 5.5. Early exposure to television for more than two hours a day, which decreased over time, did not cause behavior or social problems. The American Academy of Pediatrics (AAP) recommends no television viewing for children under age 2, and no more than two hours of daily media exposure for ages 2 and older.

PEER-LED, SCHOOL-BASED ANTI-OBESITY PROGRAM A SUCCESS

A trial program in two Canadian elementary schools that paired older and younger students in a healthy lifestyle/obesity prevention program, improved health and nutrition knowledge in all grade levels, and decreased weight in older students. Through "Healthy Buddies" www.healthybuddies.ca , teachers worked with older students on various nutrition, physical activity and healthy body image lessons. The older children would then act as teachers and pass the information on to their younger "buddies." The student-led curriculum improved health, nutrition and lifestyle knowledge not only in the older children, but also in their younger buddies. In addition, weight gain decreased in the older students. The authors of the study, "Healthy Buddies: A Novel, Peer-Led Health Promotion Program for the Prevention of Obesity and Eating Disorders in Children in Elementary School," recommend
student-led teaching programs as an efficient, easy-to-implement way of promoting a healthy lifestyle in school-age children.

FEELING RELAXED AFTER CIGARETTE STRONG PREDICTOR OF ADDICTION

Adolescents who reported feeling relaxed after their first cigarette were more likely to become addicted to nicotine, according to the study, "Susceptibility to Nicotine Dependence: Development and Assessment of Nicotine Dependence in Youth 2." Researchers interviewed 217 6th grade students (average age 12.2) on their tobacco use and dependency. And while few risk factors or individual characteristics emerged to predict nicotine addiction in general, a feeling of relaxation after the first cigarette was the strongest predictor of both dependence and an inability to stop smoking. A depressed mood also was a predictor.
Neither predictor was altered by other risk or psychosocial factors. Familiarity with Joe Camel - the advertising mascot from 1987 to 1997 for Camel cigarettes - and having the novelty-seeking personality trait predicted nicotine use. According to the study authors, tobacco marketing should be banned to prevent youths from experimenting and ultimately becoming addicted to cigarettes.

HEART ATTACKS MAY OCCUR IN ADOLESCENTS WITHOUT HEART ABNORMALITIES

Heart attacks (myocardial infarctions) can occur in adolescents without heart abnormalities, according to a new study. In "Myocardial Infarction in Healthy Adolescents," researchers reviewed the health information of nine, healthy adolescents, ages 12 to 20 (eight boys and one girl), who had severe chest pains and myocardial infarctions between June 1995 and May 2006. One patient reported taking amphetamines; however, the other eight were drug free. No congenital coronary or cardiac anomalies were found in any of the patients, and none had coronary thrombosis (a blood clot in the artery). For each of the nine patients, chest pain was alleviated through nitroglycerin therapy. According to the study authors, adolescent emergency room visits for chest pain are common, and while most often the pain is not cardiac-related, select patients should receive electrocardiograms and cardiac enzyme workups. Patients suspected of acute attack, should receive additional tests and follow-up care.

[EDITOR'S NOTE: A related study, "Contribution of Inherited Heart Disease to Sudden Cardiac Death in Children," found that sudden cardiac death in children is most often caused by inherited cardiac disease. Therefore, family members of a child who died suddenly from cardiac arrest should be screened for possible heart disease, which can be alleviated and prevented with appropriate treatment and care.]

NO LINK BETWEEN BREASTFEEDING AND TOOTH DECAY

Breastfeeding does not cause early childhood tooth decay, according to a new study. "Association Between Infant Breastfeeding and Early Childhood Caries in the United States" analyzed data on oral health, infant feeding, and numerous other factors among children ages 2 to 5, in the 1999-2002 National Health and Nutrition Examination Survey. Despite some reports that link breastfeeding, especially prolonged breastfeeding, with dental caries, this study found no such increased risk. In contrast, maternal smoking was found to increase the risk for dental caries.

PHYSICIAN-PARENT E-MAIL IMPROVES COMMUNICATION AND PATIENT CARE

Parents who have e-mail access to their child's physician report improved communication and care. In a new study, "Patient-Physician E-mail: An Opportunity to Transform Pediatric Health Care Delivery," 121 families in a pediatric rheumatology practice used a physician e-mail service over a two-year period. During that time, data was recorded on each message, including its level of urgency, subject, volume, time received, and physician time spent responding to the e-mail. At the same time, similar data was collected on parent questions called in by telephone. The study found that physicians were able to complete e-mail responses 57 percent faster than returned phone calls. In addition, the families who utilized the e-mail service reported greater access to their doctor, and improved care. E-mail communication between parents and pediatricians and pediatric subspecialists can help
provide optimal consumer-driven health care, according to the study authors.

[EDITOR'S NOTE: In a related study, "Impact of Clinical Alerts Within an Electronic Health Record on Routine Childhood Immunization in an Urban Pediatric Population," researchers found that electronic health record systems that alerted medical staff when patients were in need of immunizations, optimized immunization opportunities at both sick and well visits, and significantly improved immunization rates at age 2.]

U.S. EMERGENCY SERVICES NOT PREPARED TO CARE FOR CHILDREN IN DISASTER

While Hurricane Katrina highlighted the need for improved disaster planning, especially for children, a recent survey of licensed U.S. prehospital emergency medical service agencies revealed that most are significantly unprepared to appropriately care for pediatric patients in a disaster. In the study, "Prehospital Preparedness for Pediatric Mass-Casualty Events," researchers surveyed 1,932 emergency medical service agencies. While most agencies (72.9 percent) reported having a written response plan for mass-casualty Events (MCS), only 13.3 percent included pediatric-specific procedures. Most (69 percent) did not have a
specific plan for responding to a mass-casualty event at a school, and only 19.2 percent had pediatric triage protocol. And while nearly 70 percent of the agencies reported participation in a regional disaster drill during the past year, less than half of the drills included pediatric victims. The study authors recommend child- specific disaster planning throughout the U.S.

MATERNAL LOW CHOLESTEROL MAY CAUSE PRETERM, LOWER-WEIGHT INFANTS

Mothers with low serum cholesterol levels are significantly more likely to deliver premature babies, or full-term babies with lower weight, according to the study, "Adverse Birth Outcomes Among Mothers With Low Serum Cholesterol." Researchers studied 118 women with low total cholesterol (less than the 10th percentile) and 940 women with mid-range cholesterol levels. The women - between the ages of 21 and 34; all nonsmokers without diabetes - were referred to South Carolina clinics for routine second-trimester prenatal care between 1996 and 2001. Among white mothers, the prevalence of preterm delivery was 21 percent for the
low cholesterol mothers, compared to 5 percent for the mid-cholesterol mothers. There were no significant increases in preterm birth rates among African American mothers. However, a low maternal serum cholesterol level was associated with lower infant birth weights at term - 150 grams less, on average - in both racial groups. In addition, a trend was found towards small head size among babies born to mothers with very low cholesterol. Low serum cholesterol levels often reflect poor diet or nutritional deficiencies. The study authors recommend that future investigations of preterm births include cholesterol and lipoprotein profiles.

[EDITOR'S NOTE: In a related commentary, "The Changing Face of Preterm Birth," the impact of Dr. Muenke's research is addressed.]

NURSE VISITS TO NEW MOTHERS PROVIDE LONG-TERM CHILD, FAMILY BENEFITS

Home nurse visits to low-income mothers - both before and after the child's birth - can provide long-term physical and social benefits for children and families, according to a new study. In "Effects of Nurse Home Visiting on Maternal and Child Functioning: Age 9 Follow-up of a Randomized Trial," researchers assigned nurse home visits, or comparable services, to 743 low-income women in Memphis, Tenn. Each of the women had at least two socio-demographic risk characteristics: unmarried, had less than 12 years of education, and/or were unemployed.The mothers received a mean of seven prenatal visits and 26 postnatal
visits over two years. Nine years after the children were born, researchers interviewed the mothers on their economic and social status. The study authors also reviewed academic and behavior reports from the children's schools. The mothers reported reduced rates of subsequent births, increased intervals between the birth of their first and second child, and more stable relationships with their partners. In addition, there were lower levels of child mortality from preventable causes, and the children had more successfully adjusted to elementary school.

SCHOOL HEALTH CENTERS PROVIDE OPTIMAL CARE FOR LOW-INCOME YOUTH

Low-income adolescents receive high-quality, frequent care at school-based health centers, according to the new study, "School-Based Health Centers: Improving Access and Quality of Care for Low-Income Adolescents." Researchers reviewed medical records from Denver Health and enrollment records from Denver public schools for low-income students, ages 14 to 17, between Aug. 1, 2002 and July 31, 2003. The students were uninsured or insured by Medicaid or the State Children's Health Insurance Program (SCHIP), and either actively used Denver Health Services' community clinics or their school-based health center. While
the school-based health center patients were less likely to be insured, they were more likely to have made three or more primary care visits during the past year; less likely to use emergency care services; and more likely to have received a health maintenance visit, a tetanus booster, and hepatitis B and influenza vaccines. According to the study authors, the results show that adolescent health care is enhanced with access to school-based clinics, in addition to traditional, out-patient care.

AAP POLICY STATEMENT URGES PEDIATRICIANS TO TAKE LEAD IN ENSURING INFANT SCREENING, DIAGNOSIS AND INTERVENTION FOR HEARING LOSS

A revised policy statement from the Joint Committee on Infant Hearing (JCIH; seven organizations, including the AAP) recommends that pediatricians take the lead in ensuring that all infants are screened for hearing loss by age 1 month, diagnosed with hearing loss by 3 months, and engaged in full intervention services by 6 months. Since 2000, when the JCIH first recommended that all infants be screened for hearing loss, the number of screened newborns dramatically increased
from 38 to 95 percent. However, almost half of the children who failed hearing screening tests did not receive appropriate, timely follow-up care. And yet medical and specialized intervention during the first year of life is needed to enhance the speech and language development of infants with hearing loss. "Year 2007 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs," recommends that pediatric offices, typically a child's first medical home, ensure timely screening, diagnosis, and coordinated medical and educational care for infants with hearing loss, optimally beginning at a
newborn's first office visit. Ongoing surveillance of developmental milestones at each visit, and an objective, standardized screening of global development is recommended at ages 9 months, 18 months, and between 24 and 30 months, and/or anytime a doctor, medical professional, or parent is concerned about hearing loss.

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.