In this mailing:

The Table of Contents (TOC) from the May issue of Pediatrics, the peer-reviewed scientific journal of the American Academy of Pediatrics (AAP), and Pediatrics electronic pages, the Internet extension of Pediatrics. These are available electronically and can be viewed at:

Current issue TOC:
http://www.pediatrics.org/current.shtml Future issue TOC:
http://www.pediatrics.org/future.shtml

Also in this mailing:

AAP POLICY STATEMENTS AND REPORTS
1. The Low-Down on Soy Protein-Based Formulas
2. School Nurses Play Critical Role in Children?s Health Services
3. Encouraging Activity for Children with Disabilities

STUDIES
4. Mental Disorders in Parents Linked to Autism in Children
5. Teen Drivers Recognize Many, But Not All, Risks
6. The Safest Seat: Appropriate Child Safety Seat Placement
7. Heart Hormone Higher in Children Who Snore and Wet the Bed
8. Children with Diabetes Show Accelerated Tooth Eruption
9. Childhood Epilepsy and Maternal Infections

NEWS RELEASES
10. First Deliveries of Realistic Neonatal Simulator to Arrive in Hospitals This Month
11. Save the Date: 2008 Pediatric Academic Societies Meeting in Hawaii
12. National Dog Bite Prevention Week is May 18-24
13. National Children?s Mental Health Awareness Day is May 8

AAP PARENTING TIPS
14. Summer Safety Tips Part 1

Note: Please attribute the source as the journal, Pediatrics when covering information from this mailing.

Below are news releases and briefs on articles appearing in the May issue of Pediatrics, the peer-reviewed, scientific journal of the American Academy of Pediatrics (AAP). To receive the full text of these articles, contact the AAP Department of Communications.

AAP POLICY STATEMENTS AND REPORTS

1. THE LOW-DOWN ON SOY PROTEIN-BASED FORMULAS

The American Academy of Pediatrics (AAP) promotes the use of human milk as the ideal source of infant nutrition. However, the majority of infants in North America are receiving some formula by two months of age. Soy protein-based infant formulas have been available for almost a century, and they account for nearly 20 percent of the formula sold in the United States. The AAP revised clinical report on "Use of Soy Protein-Based Formulas in Infant Feeding," states that there are few indications for the use of soy protein-based formula in place of cow milk-based formula in term infants. Soy formula has no proven value in the prevention or management of colic or fussiness, and it does not have an advantage over cow milk protein-based formula as a supplement for breastfed infants. Extensively hydrolyzed protein formula should be given to infants with cow milk allergy because 10 percent to 14 percent of these infants will also have a soy protein allergy. In addition, soy protein-based formulas are not recommended for preterm infants. The only real indications for this formula are for infants with congenital galactosemia, for use by families who are strict vegans or in infants who are truly lactose intolerant as soy protein-based formulas are lactose free.

[Embargoed until Monday, May 5, at 12:01 a.m. ET. For more information, contact Jatinder Bhatia, MD, FAAP, at 706-721-2331, JATINDEB@mail.mcg.edu or Frank Greer, MD, FAAP, at 608-417-6236, frgreer@pediatrics.wisc.edu]

2. SCHOOL NURSES PLAY CRITICAL ROLE IN CHILDREN?S HEALTH SERVICES

As more students enter school with health or mental health problems, the role of the school nurse becomes an important aspect of a child?s overall health plan. School nurses provide a bridge between home, school and the pediatrician. Students today may face family crises, homelessness, immigration, poverty or violence, all of which can impact their health and ability to learn. Previous studies have shown that student outcomes are improved when a full-time school nurse is on staff. To support the role of school nurses and foster a relationship among school nurses, pediatricians and families, the American Academy of Pediatrics has issued a revised policy statement, "Role of the School Nurse in Providing School Health Services." The statement encourages pediatricians to establish a working relationship with school nurses who care for their patients and coordinate with school nurses on vision and hearing screening to ensure children who need additional evaluations are referred appropriately. Pediatricians also can play an active role in supporting school nurses by serving on school wellness policy committees and emergency preparedness committees.

[Embargoed until Monday, May 5, at 12:01 a.m. ET. For more information, contact Harold Magalnick, MD, FAAP, 602-375-4269, halmag@aol.com ]

3. ENCOURAGING ACTIVITY FOR CHILDREN WITH DISABILITIES

The benefits of physical activity are universal for all children, including those with disabilities. Participation in physical activities provides opportunities to form friendships, develop skills, express creativity and achieve mental and physical health. But children with disabilities are often excluded from participating in these activities. The American Academy of Pediatrics has issued a clinical report, ?Promoting the Participation of Children with Disabilities in Sports, Recreation and Physical Activities,? to help pediatricians ensure that children with disabilities are given opportunities to become involved. The report advises pediatricians to perform pre-participation exams involving the family, coach and others. They also should identify ways to minimize risk of illness and injury, and advocate for the participation of all children -- including those with disabilities -- in sports and physical activity programs.

[Embargoed until Monday, May 5, at 12:01 a.m. ET. For more information, contact Nancy Murphy, MD, FAAP, at 801-587-9978, nancy.murphy@hsc.utah.edu or Paul Carbone, MD, FAAP at 801-585-5857, Paul.Carbone@hsc.utah.edu ]

STUDIES

4. MENTAL DISORDERS IN PARENTS LINKED TO AUTISM IN CHILDREN

Parents of children with autism were roughly twice as likely to have been hospitalized for a mental disorder, such as schizophrenia, than parents of other children, in an analysis of Swedish birth and hospital records. The study, ?Parental Psychiatric Disorders Associated With Autism Spectrum Disorders in the Offspring,? examined 1,237 children born between 1977 and 2003 who were diagnosed with autism before age 10, and compared them with 30,925 control subjects matched for gender, year of birth and hospital. Previous research has found psychiatric disorders are more common among family members of individuals with autism, a finding replicated in this study. The large sample size of this study enabled researchers to distinguish between psychiatric history among mothers versus fathers in relation to autism. Both mothers and fathers with schizophrenia were about twice as likely to have a child diagnosed with autism. For other disorders, including depression and neurotic and personality disorder, an association with childhood autism was found only for maternal disorders, not for paternal disorders. The association was present regardless of the timing of the parent?s diagnosis relative to the child?s diagnosis. The results support the hypothesis that there is a familial predisposition that presents differently in the parent than in the child and probably requires other genetic or environmental factors to be expressed.

[Embargoed until Monday, May 5, at 12:01 a.m. ET. For more information, contact Ramona DuBose at 919-966-7467 or ramona_dubose@unc.edu ]

5. TEEN DRIVERS RECOGNIZE MANY, BUT NOT ALL, RISKS

With prom season and summer vacation just around the corner, teen drivers may find themselves in any of a long list of unsafe driving situations. A survey of more than 5,000 high school students examined teen attitudes about 25 risky driving situations and identified important gaps in their perceptions about factors that can lead to accidents. According to the study, "National Young-Driver Survey: Teen Perspective and Experience With Factors That Affect Driving Safety," 60 percent of teens believed inexperience heavily influences safety, but did not consider their peers to be inexperienced. Teens also revealed important nuances in the way they ranked distractions: 10 percent recognized passengers as a potential hazard, but more acknowledged that passengers who acted in certain ways posed a risk. Similarly, the respondents did not consider cell phones particularly risky unless their use evoked certain emotional responses. The study also revealed that certain subgroups of teens are not receiving adequate education about risks such as speeding, and drinking and driving. Caucasian youth viewed speeding as less risky, while reporting they see it more often among their peers than African American and Hispanic youth did. Meanwhile, African American and Hispanic youth viewed drinking alcohol while driving as less risky, and reported seeing it more often among their peers than did Caucasian youth. Adults who are equipped with these insights into teens' perceptions may be better positioned to reach them with messages about safe driving.

[Embargoed until Monday, May 5, at 12:01 a.m. ET. For more information, contact Dana Mortensen, at mortensen@email.chop.edu or (267-426-6092)]

6. THE SAFEST SEAT: APPROPRIATE CHILD SAFETY SEAT PLACEMENT

Child safety seats installed in the rear seat of a motor vehicle protect children in motor vehicle crashes. Recent advances in child-restraint system (CRS) design and changing patterns of child safety seat use have prompted the need to reevaluate the evidence in support of these recommendations. In the study, ?Seating Patterns and Corresponding Risk of Injury Among 0- to 3-Year-Old Children in Child Safety Seats,? the most common seating position for children using a CRS is the rear passenger side. Use of this position increases as children get older. However, child occupants aged 0-3 years seated in the center rear had a 43 percent lower injury risk compared with children in either of the rear outboard positions. Study authors offer updated evidence for the current recommendations that the center rear is the safest seat position for children restrained in a CRS, but they do not indicate that a child seated in an outboard position is a poor choice. Rather, they suggest that installing a CRS in the center rear position further reduces the risk of injury and enhances the protection already offered by child safety seats installed in the outboard position.

[Embargoed until Monday, May 5, at 12:01 a.m. ET. For more information contact Dana Mortensen from The Children?s Hospital of Philadelphia at 267-426-6092 or mortensen@email.chop.edu ]

7. HEART HORMONE HIGHER IN CHILDREN WHO SNORE AND WET THE BED

Children who snore are more likely to wet the bed during the night and also have higher levels of a heart hormone that helps regulate fluids in the body, according to the study, ?Increased Morning Brain Natriuretic Peptide Levels in Children with Nocturnal Enuresis and Sleep-Disordered Breathing: A Community-Based Study.? Researchers collected surveys about the sleeping habits of children ages 5 to 7 in 17,646 families in Kentucky. A subset of 378 children also underwent sleep studies in a lab, where researchers measured their breathing, heart rate, oxygen saturation, sleep position, blood samples and bed wetting. In the study, nearly 27 percent of children who snored also wet the bed, compared to 11.6 percent of children who didn?t snore. The frequency of bed-wetting among snoring children was not affected by the severity of sleep disordered breathing. However, bed-wetters did have elevated morning levels of brain natriuretic peptide (BNP), a hormone synthesized in the heart that can be an indicator of heart function. BNP increases sodium and water excretion and inhibits other hormones that regulate fluids in the body. The authors suggest that sleep fragmentation and the release of BNP may contribute to bed-wetting among children who snore.

[Embargoed until Monday, May 5, at 12:01 a.m. ET. For more information, contact David Gozal, MD, 502-852-2323, david.gozal@louisville.edu or Leila Kheirandish-Gozal, 502-852-5262, l0kheio1@gwise.louisville.edu ]

8. CHILDREN WITH DIABETES SHOW ACCELERATED TOOTH ERUPTION

In addition to being a risk factor for gum disease, diabetes mellitus can cause accelerated tooth eruption in children, according to the study ?Accelerated Tooth Eruption in Children with Diabetes Mellitus.? Researchers studied 270 children ages 6 to 14 with diabetes (primarily type 1 diabetes) and 320 healthy children in the same age range. Participants answered questions about their medical and dental history and had regular dental exams. Among children ages 10 to 14, those with diabetes had accelerated dental development compared to healthy children. A higher body mass index and gingival inflammation were also associated with expedited tooth eruption, a process that starts with teeth emerging from the gums and moving into their final positions in the mouth. It is unknown whether such aberrations in eruption lead to a greater risk for dental crowding or orthodontic care in children. For now, the authors suggest a greater emphasis on regular dental care aimed at health promotion and disease prevention, especially in children with diabetes mellitus.

[Embargoed until Monday, May 5, at 12:01 a.m. ET. For more information, contact Shantanu Lal, DDS, 212-305-1041, SL784@columbia.edu or Ira B. Lamster, DDS, MMSc, 212-305-4511, IBL1@columbia.edu ]

Editor?s note: The May issue includes two other studies related to diabetes: ?Obesity and Type 2 Diabetes Risk in Midadult Life: The Role of Childhood Adversity,? and ?Presence of Diabetic Ketoacidosis at Diagnosis of Diabetes Mellitus in Youth.?

9. CHILDHOOD EPILEPSY AND MATERNAL INFECTIONS

Epilepsy, a disorder of the nervous system characterized by recurrent seizures, affects 1 percent of the population before the age of 20. Less than 20 percent of these cases have a known cause, but maternal infections have been associated with an increased risk of some neurological disorders. In ?Prenatal Exposure to Maternal Infections and Epilepsy in Childhood: A Population-Based Cohort Study,? researchers studied 90,619 children for up to eight years and diagnosed 646 children with epilepsy. Children exposed to some maternal infections during pregnancy (bladder infection, diarrhea, cough or vaginal yeast infection) had an increased risk for epilepsy in childhood. The mechanisms underlying the associations remain unsettled. The research group is planning another study to explore the possible mechanisms and replicate the findings by using biomarkers of infection. If the findings are causal, they have implications on the etiology and prevention of childhood epilepsy.

[Embargoed until Monday, May 5, at 12:01 a.m. ET. For more information, contact Yuelian Sun, MD, at the Department of Epidemiology, University of Aarhus, Denmark, at (45) 8942 6111 or ys@soci.au.dk or Jorn Olsen, Professor and Chair, UCLA School of Public Health at 310-825-3516 or jo@ucla.edu ]

NEWS RELEASES

10. First deliveries of realistic neonatal simulator to arrive in hospitals this month

For release: May 5, 2008

AAP media contact:
Susan Stevens Martin
847-434-7131
ssmartin@aap.org

Laerdal Medical Contact:
Chris Devenny
800-648-1851 ext. 3237
chris.devenny@laerdal.com

May 5, 2008, CHICAGO -- She cries and hiccups. She has a heart beat, moves her arms and legs and will turn blue if she?s not getting enough oxygen. The SimNewB, a new neonatal patient simulator developed through a strategic alliance between the American Academy of Pediatrics (AAP) and Laerdal Medical, features realistic newborn traits and lifelike clinical feedback that will help health care professionals learn to resuscitate their most vulnerable patients.

The SimNewB will play a vital role in the redesign of neonatal resuscitation training programs to a more interactive model, said Jay Goldsmith, MD, FAAP, co-chair of the AAP?s Neonatal Resuscitation Program Steering Committee. Rather than lecture-intensive courses, programs are shifting to emphasize hands-on, interactive training.

?Medicine in general is coming to believe that simulation training is the best training you can have,? Goldsmith said. ?The mantra is ?suspension of disbelief.? We see trainees coming into the course chewing gum, laughing and talking. When we make the scenario believable, they get serious. They start to believe their skills are being tested.?

Immersive, simulation-based training results in better retention of cognitive, technical and behavioral skills, and leads to better communication, teamwork and leadership among health care professionals, Goldsmith said.

To support this new approach, the AAP issued a request for proposals for a newborn simulator that would align with medical guidelines for neonatal resuscitation. Laerdal, a Norway-based manufacturer, delivered the SimNewB, a 7-pound, 21-inch female newborn mannequin. Laerdal engineers worked closely with the AAP to design a simulator that mimics a newborn?s complex physiological responses to a wide range of variables. The SimNewB is fully integrated with the AAP?s guidelines for neonatal resuscitation, creating an effective learning tool.

?It was a great experience to work so closely with the American Academy of Pediatrics on this important project,? said Clive Patrickson, PhD, president of Laerdal in the Americas. ?By working together from the very start, we have been able to ensure that the simulator meets the essential requirements that the AAP was looking for when it issued the request for proposals.?

?The SimNewB is a revolutionary training tool,? said Louis P. Halamek, MD, FAAP, co-chair of the AAP?s Neonatal Resuscitation Program Steering Committee. ?It will create a realistic training experience that?s based on the learning objectives of the Neonatal Resuscitation Program.?

The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. Learn more at http://www.aap.org.

Laerdal Medical, one of the world?s leading providers of Healthcare Solutions, is dedicated to helping save lives with products and services for Airway Management, Immobilization, Basic Life Support, Advanced Life Support, Patient Care, Self-Directed Learning, and Medical Education. Laerdal is pleased to serve all healthcare providers and educators, from the lay rescuer to the medical professional. http://www.laerdal.com.

11. SAVE THE DATE: 2008 PEDIATRIC ACADEMIC SOCIETIES MEETING IN HAWAII.

The annual meeting of the Pediatric Academic Societies (PAS) is May 3-6 at the Hawaii Convention Center in Honolulu. Top international research and new advancements in pediatrics will be the focus of more than 3,000 presentations. Nearly 6,500 leaders in pediatric science, advocacy and patient care will attend, including 1,000 participants from Asia. The conference is co-sponsored by the institutional members of the PAS: the Ambulatory Pediatric Association, the American Academy of Pediatrics, the American Pediatric Society and the Society for Pediatric Research. This year, the meeting will be held in conjunction with the Asian Society for Pediatric Research. For more information or to view news releases on selected studies, visit http://www.aap.org/pressroom/pas/ For press passes, contact Debbie Linchesky at 847-434-7084 or dlinchesky@aap.org

12. NATIONAL DOG BITE PREVENTION WEEK IS MAY 18-24

Every year, dogs bite 4.7 million Americans, with 48 percent of all reported bites to victims younger than 10 years old. Children are 300 times more likely than adults to be bitten. The AAP supports National Dog Bite Prevention Week, May 18-24, to help educate children about how to stay safe around dogs of all sizes. For more information visit http://www.preventthebite.com

13. NATIONAL CHILDREN?S MENTAL HEALTH AWARENESS DAY IS MAY 8

The AAP is co-sponsoring National Children?s Mental Health Awareness Day on May 8. This year's theme, "Thriving in the Community," focuses on getting high schoolers the help and support they need. More information is available at http://systemsofcare.samhsa.gov/nationalawareness/materials.aspx and at http://www.aap.org

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14. SUMMER SAFETY TIPS

Keep your family safe this summer with up-to-date tips from the AAP on sun exposure, heat stress, pool safety, insects, playground dangers, bike and skateboard safety, and lawnmowers. http://www.aap.org/advocacy/releases/summertips.cfm

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The FAAP designation following a pediatrician?s name stands for Fellow of the American Academy of Pediatrics. Pediatricians with a FAAP designation have obtained board certification in pediatrics and made an ongoing commitment to lifelong learning and advocacy for children.

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