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Below are news releases and briefs on statements appearing in the September issue of Pediatrics, the peer-reviewed, scientific journal of the American Academy of Pediatrics (AAP). For Release: September 4, 2007, 12:01 am (ET)
Children who watch more television in their early years may be more likely to have attention problems as teens. In a study from the University of Otago, in Dunedin, New Zealand, more than 1,000 children were observed from age 3 through age 15. Early childhood attention problems were noted at ages 3 and 5. Parents’ estimates of the children’s’ television viewing time were obtained at ages 5, 7, 9 and 11. Then, using various tools and questionnaires, the parents, the children themselves and reported on attention problems at ages 13 and 15. For every additional 50 minutes of television watched on average per day, there was a measurable negative impact on attention. Those who watched the most TV earlier in childhood were more likely to have attention problems. In particular, those children who watched more than two hours per day had above-average symptoms of attention difficulties in adolescence. Early childhood attention problems, socioeconomic status, gender or cognitive abilities did not influence the results, leading the researchers to conclude that watching too much TV was the most likely cause. Possible explanations may be the world portrayed on television makes real-life tasks seem boring in comparison, or that watching TV displaces of the activities that encourage attention such as reading and playing games. According to a recent Institute of Medicine report, there is strong evidence that television advertising influences short-term food preferences for children 2 to 11 years of age. Researchers for the study, “Nutritional Content of Television Food Advertisements Seen by Children and Adolescents in the United States,” analyzed food-product advertisements seen by children and adolescents on top-rated television shows from September 2003 to May 2004. Nearly 98 percent of food ads seen by children 2 to 11 years old and 89 percent for adolescents 12 to 18 years old were for products high in fat, sugar, or sodium and of poor nutritional content. Fast-food restaurants made up the largest category of all food-related advertisements viewed by teens, while children 2-11 years of age most frequently saw cereal ads. The current obesity epidemic among children and adolescents has challenged the food and beverage industries to reexamine their marketing practices. These findings will provide a benchmark against which future research can evaluate the commitment by food companies to change the nature of food advertising to children. EDITOR’S NOTE: The AAP released a revised policy statement “Children, Adolescents, and Advertising,” in December 2006. The statement has several recommendations to help mitigate advertising’s harmful effects, but says one simple solution would be to have children and adolescents become critical media viewers, also known as being media literate. WARNING SIGNS: DEPRESSION AND TEEN SUICIDE According to the American Academy of Pediatrics (AAP) revised clinical report, "Suicide and Suicide Attempts in Adolescents," more than 90 percent of adolescent suicide victims met criteria for a psychiatric disorder before their death, increasing the importance of timely evaluation and referral of teenage patients when mental illness is suspected. The report includes a new section on antidepressant medications and suicide. Since the FDA directed pharmaceutical companies to include a black-box warning on all antidepressant medications in 2004, there has been a decrease in prescriptions. Concern has been expressed that this reduction of antidepressant prescribing may be related to an 18 percent increase in U.S. youth suicides from 2003 to 2004 after a decade of steady declines. Regardless of whether the use of antidepressant medications changes the risk of suicide, depression is an important suicide risk factor, and careful monitoring of adolescents’ mental health and behavioral status is critically important, particularly when initiating or changing treatment. Warning signs for family members to contact the physician include: New or more frequent thoughts of wanting to die
Additional risk factors for suicide include intoxication, agitation, and a recent stressful life event. Teens are also at a much greater risk than adults of being influenced by the media, and may imitate suicidal behavior seen on television. More than 250 million women throughout the world smoke tobacco, and those who smoke while pregnant pose a serious health risk to themselves and their unborn children. These threats continue after birth when infants are exposed to nicotine and other toxicities of cigarette smoke in breast milk. The study, “Breastfeeding and Smoking: Short-term Effects on Infant Feeding and Sleep,” examined how breastfeeding from a mother who smokes affects sleep and activity patterns in infants. Analysis conducted at the Monell Chemical Senses Center showed that infants spent considerably less time sleeping during the hours immediately after their mothers smoked than when mothers refrained from smoking. In addition to the damaging effects of nicotine on the developing infant brain, research has shown that maternal smoking during early childhood increases the risk that the child will smoke during adolescence. The authors suggest that perhaps concerns that their milk would taste like cigarettes and their infants’ sleep patterns would be disrupted would motivate lactating mothers to abstain from smoking. Computed tomography (CT) scans are essential for the evaluation of many childhood disorders. Recent reports have expressed concern that the radiation required for CT scans may pose a cancer risk. The new American Academy of Pediatrics (AAP) clinical report, “Radiation Risk to Children From Computed Tomography,” notes that the benefits of an indicated CT scan far outweigh the risks of causing cancer in children, and should continue to be used when needed. Radiologists are advised to adjust the radiation level according to the size of the child, and to use the lowest radiation dose possible in order to achieve an accurate examination. Pediatric health care professionals should be prepared to discuss the benefits and risks with patients and families when a CT scan is planned. Adequate calcium intake in early adolescence has a significant impact on future bone density and the risk of osteoporosis later in life. But a study of 230 girls found that many avoid dairy products due to perceived milk intolerance (PMI). “Perceived Milk Intolerance is Related to Bone Mineral Content in 10- to 13-Year-Old Female Adolescents,” found that 47 percent of Hispanic girls, 68 percent of Asian girls, and 12 percent of non-Hispanic White girls could be classified as lactose maldigesters. However, most lactose maldigesters do not experience symptoms of intolerance. The authors pose that lactose intolerance is highly individual and influenced by physiologic and psychological factors. Because early adolescence is a time when calcium intake has a significant effect increasing bone mineral calcium levels, PMI is especially threatening to bone health. The authors suggest it is important to address misconceptions about lactose intolerance early in life in order to reduce future cases of osteoporosis. Childhood iron-deficiency anemia, which affects 490,000 U.S. children, is associated with behavioral and cognitive delays. Analysis of national data from 1,641 toddlers in the study, “Iron Deficiency in Early Childhood in the United States: Risk Factors and Racial/Ethnic Disparities,” found iron deficiency prevalence was 12 percent among Hispanics versus 6 percent in both whites and blacks. It was found that toddlers who are overweight are at high risk for iron deficiency. In contrast, day care/preschool attendance was found to be protective against iron deficiency. The study data showed that Hispanic toddlers are more likely than white and black toddlers to be overweight and not in day care, which may account for their increased risk of iron deficiency. ITCHY SKIN VISITS INCREASING Atopic dermatitis (AD), often referred to as eczema, is a common chronic inflammatory skin disease of childhood characterized by red, itchy, dry skin. The study, “Atopic Dermatitis in Children in the United States, 1997-2004: Visit Trends, Patient and Provider Characteristics, and Prescribing Patterns” analyzed a national database and found that the number of estimated physician office visits for the diagnosis of AD has increased over time. Black and Asian children were more likely than white children to be seen for diagnosis of AD. The authors also found that recommended first-line treatment options for AD in children, such as topical corticosteroids, were prescribed in one in three pediatric visits for AD. A variety of other treatments were prescribed in the remainder of pediatric visits for AD. INTERNATIONALLY ADOPTED CHILDREN SHOULD BE TESTED FOR TB INFECTION The study, “Predictors of Mycobacterium tuberculosis Infection in International Adoptees,” suggests high rates of M tuberculosis infection and malnutrition in internationally adopted children, which places them at considerable risk for progression to active tuberculosis. Children under age two were at the greatest risk for acquiring M tuberculosis infection. This may be due to the fact that younger children have closer contact with caregivers and spend more time indoors. Due to long-term exposure, older children who spent more time in a region that has a high rate of known tuberculin infection are more likely to test positive. Anyone with active tuberculosis is at risk of passing the infection along to others in their care. The authors recommend complete tuberculin testing soon after adoption. Also, because malnutrition and/or recent infection can mask tuberculosis test findings, doctors should consider repeating the skin test again at three to six months after children arrive in their adoptive countries and their nutrition has improved. For nearly 50 years, doctors have been prescribing antibiotics for patients with almost any form of congenital or acquired heart disease before medical and dental procedures. Now, however, new recommendations from the American Heart Association (AHA) have called that practice into question. The AHA's Endocarditis Committee together with an affiliated writing group of international experts, after a comprehensive review of the data and of the literature available, concluded that routine use of prophylactic antibiotics at times of medical or dental procedures in a attempt to prevent endocarditis (inflammation of the heart and its valves) is not warranted for most individuals with congenital or acquired heart disease. However, the group did recognize that in certain specific situations, including patients with prosthetic heart valves or other complex conditions where the risk of an adverse outcome would be highest, antibiotic prophylaxis for dental procedures is still a reasonable option. The AHA recommendations urge patients to review their personal circumstances with their own providers, and remind all patients that maintenance of good oral hygiene should be part of every patient's regular healthcare. The AAP endorses these new recommendations. A supplement to the September issue of Pediatrics contains findings and conclusions of a 2006 Workgroup Meeting on Use of Family History Information in Pediatric Primary Care and Public Health in Atlanta, Georgia. The meeting was sponsored by the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. The supplement includes information on such topics as: · Linking family history in obstetric and pediatric care AAP Contact: Debbie Linchesky, 847-434-7084, dlinchesky@aap.org or Mindy Weinstein, 847-434-7131, mweinstein@aap.org For immediate release. Digital cover image is available. NEW AAP PARENTING BOOK TAKES THE BATTLE OUT OF FEEDING INFANTS, TODDLERS AND YOUNG CHILDREN CHICAGO - Getting kids to eat healthy is a challenge when at times parents can barely get their kids to eat at all. A new book published by the American Academy of Pediatrics (AAP), “Food Fights: Winning the Nutritional Challenges of Parenthood Armed With Insight, Humor, and a Bottle of Ketchup,” offers simple and realistic strategies for introducing children to lifelong healthy eating habits starting from day one. Written by two accomplished pediatricians who are also parents, Laura A. Jana, MD, FAAP, and Jennifer Shu, MD, FAAP, bring together the science of nutrition with the practical insight of those who have been through mealtime melees themselves. It serves up dozens of simple solutions to everyday behavioral issues and developmental factors that can make feeding children a challenge. Medically sound, reality-based suggestions enable parents and caregivers to put nutrition recommendations into practice, offering simple and efficient ways to encourage healthy eating habits in the home, at child care, at school, and when eating out. With step-by-step instructions and a huge helping of humor, this insightful new handbook covers the food fights parents are most likely to face - and helps them decide which battles just aren’t worth fighting. The AAP is an organization of 60,000 primary health care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well being of infants, children, adolescents and young adults. FALL ALLERGY TIPS
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