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Kids with Sickle Cell Disease More Likely to Have Physical and Developmental Health Problems

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The first national estimate on the health status of children with sickle cell disease revealed that black children with sickle cell disease are more likely to have intellectual disabilities, hearing deficits, and frequent severe headaches or migraines than black children without sickle cell disease. The study by the Centers for Disease Control and Prevention (CDC), “Health Status and Healthcare Use in a National Sample of Children with Sickle Cell Disease,” was published in the American Journal of Preventive Medicine.

The study found that black children with sickle cell disease are four times more likely to have fair or poor health status, twice as likely to have recently visited a mental health professional and have received special educational or early intervention services more often compared with black children without sickle cell disease.

Sickle cell disease is a group of red blood cell disorders that is inherited, passed from parents to children. In sickle cell disease, the red blood cells become hard and sticky, and take on a sickle shape. When the C-shaped cells travel through small blood vessels, they clog the vessels and can block blood flow. In addition, the sickled cells die earlier than normal blood cells, which creates a constant shortage of red blood cells.

“In the United States, sickle cell disease is one of the most common genetic disorders; more than 20 percent of children with SCD had recently visited a health care provider such as an optometrist or an ophthalmologist, and had more than one visit to the emergency department in the past year,” said Sheree Boulet, DrPH, with CDC’s Division of Blood Disorders. “The findings of this study emphasize the importance of screening children with sickle cell disease for thinking ability, hearing, and vision problems.”

Further, despite the increased use of health care services, the data showed that more parents indicated that they could not get an appointment for their child soon enough (10.5 percent, compared to 3.9 percent of parents whose children did not have SCD), reported waiting too long in the doctor’s office (8.7 percent versus 4 percent), and could not get through to their doctor on the telephone (7.5 percent versus 1.8 percent).

“This study gives a better insight into the types of disabilities children with sickle cell disease have and can help health care providers plan comprehensive treatments for children with the disease,” said Dr. Boulet.

The study analyzed data from the 1997–2005 National Health Interview Surveys (NHIS) to describe health status and health services use among black children 0-17 years of age with SCD.  The NHIS has monitored the health of the nation since 1957; it is the principal source of information on the health of the civilian noninstitutionalized population of the United States and is one of the major data collection programs of the National Center for Health Statistics (NCHS) which is part of the Centers for Disease Control and Prevention (CDC). NHIS data on a broad range of health topics are collected through personal household interviews.

Source: Centers for Disease Control (CDC), March 23, 2010

Children’s Behavioral Problems May Be the Result of Sleep Apnea

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Sleep apnea, not attention deficit disorder, may be the real reason for thousands of kids’ behavioral problems. Obstructive sleep apnea due to enlarged tonsils can cause repeated night-time arrestation of breathing resulting in sleep deprivation, according to ear, nose and throat physicians.

“If kids aren’t sleeping at night it can affect their school work and mental development,” says Stephen Landers, M.D., ear, nose and throat physician on the medical staff at Our Children’s House at Baylor. And kids so affected are sometimes misdiagnosed with learning disabilities. “If children are allowed to sleep properly a lot of these behavioral issues are improved,” adds Dr. Landers.

Parents needing top know whether their children’s ADD or ADHO is actually the result of sleep apnea are encouraged to watch their child sleeping at night. If they snore loudly or make gasping or snorting noises, these could be signs of sleep apnea and the family phyisician should be advised immediately.

In adults, sleep apnea is often caused by excess weight, but in 90 percent of pediatric cases, it is caused by enlarged tonsils. Fortunately, a tonsillectomy can usually treat obstructive sleep apnea in children.

Controversial Recommendation to Consider Statins for Kids with High Cholesterol

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The American Academy of Pediatrics has issued new cholesterol screening and treatment recommendations for children that suggest cholesterol screening, and possible use of statins for certain children.

The policy statement, “Lipid Screening and Cardiovascular Health in Childhood,” recommends cholesterol screening of children and adolescents with a family history of high cholesterol or heart disease. It also recommends screening patients whose family history is unknown or those who have other factors for heart disease including obesity, high blood pressure or diabetes.

The AAP suggests that screening should take place after age two, but no later than age 10. The best method for testing, according to the organization’s policy statement, is a fasting lipid profile. If a child has values within the normal range, testing should be repeated in three to five years.

The American Academy of Pedatrics suggests that for children who are more than eight years old and who have high LDL concentrations, cholesterol-reducing medications should be considered. Younger patients with elevated cholesterol readings should focus on weight reduction and increased activity while receiving nutritional counseling.

The policy statement also recommends the use of reduced-fat dairy products, such as two percent milk, for children as young as one year of age for whom overweight or obesity is a concern.

Source: American Academy of Pediatrics, July 7, 2008

Risk of Childhood Allergy and Atopic Diseases Increased by Traffic Pollution

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The risk of childhood allergy and atopic diseases is increased 50% by traffic-related pollution, according to a recent study by a German research organization.

“Children living very close to a major road are likely to be exposed not only to a higher amount of traffic-derived particles and gases but also to more freshly emitted aerosols which may be more toxic,” writes Dr. Heinrich. He continued: “Our findings provide strong evidence for the adverse effects of traffic-related air pollutants on atopic diseases as well as on allergic sensitization.”

The study’s author, Joachim Heinrich, Ph.D., of the German Research Center for Environment and Health at the Institute of Epidemiology, in Munich, checked close to 2900 children aged 4, and more than 3000 children aged 6 to establish their rates of asthma and allergy in relation to longterm exposure to traffic-related pollution.

Both groups of children came from the Munich area, and their exposure to traffic pollutants was calculated on the basis opf their homes’ distance from major roads at birth, and at two, three and six years of age. The parents completed questionnaires documenting their child’s respiratory symptoms and diagnoses, and the children were evaluated for asthma, wheezing, sneezing and eczema. The children were checked for food allergies at age six, and air was tested for particulate matter nd nitrogen dioxide at 40 high traffic areas between 1999 and 2000.

Significant positive associations were found between the distance to the nearest road and incidence of asthmatic bronchitis, hay fever, eczema and allergic sensitizations. Also noted was a relationship between proximity to a road and risk of allergic sensitization—subjects living closest to major roads had an almost 50% greater risk of allergic sensitization.

In this study, it was possible to determine that economic factors were not a confounding variable in the analysis, but there was a clear difference in the children’s allergic development with relation to their proximity to a road.

Source: American Journal of Respiratory and Critical Care Medicine, June, 2008 (2nd ed)

Risk of Type 1 Diabetes in Children Related to Vitamin D and Sun

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Researchers have found that the risk of Type 1 diabetes in children may be strongly associated with Vitamin D and exposure to sunshine.

Low incidence of type 1 diabetes was noted in people living in equatorial regions, while higher incidence was noted in populations at higher latitudes where sunlight was scarcer.

Photosynthesis of vitamin D3 is set in motion by ultraviolet exposure, while this form of vitamin D is also available through diet and supplements. "This is the first study, to our knowledge, to show that higher serum levels of vitamin D are associated with reduced incidence rates of type 1 diabetes worldwide," said Cedric F. Garland, Dr. P.H., professor of Family and Preventive Medicine in the UCSD School of Medicine, and a member of the Moores UCSD Cancer Center.

About 1.5 million Americans cope with type 12 diabetes every day, and type 1 diabetes ranks second only to asthma as the most chronic disease among children. Type 1 diabetes is diagnosed in some 15,000 Americans each year, and causes blindness and kidney failure in youth and middle age.

"This research suggests that childhood type 1 diabetes may be preventable with a modest intake of vitamin D3 (1000 IU/day) for children, ideally with 5 to 10 minutes of sunlight around noontime, when good weather allows," said Garland. "Infants less than a year old should not be given more than 400 IU per day without consulting a doctor. Hats and dark glasses are a good idea to wear when in the sun at any age, and can be used if the child will tolerate them."

Even after allowing for the fact that equatorial regions will have lower per capita healthcare expenditures than more developed countries, the association of UVB irradiance to incidence of type 1 diabetes remained strong. The researchers created a graph with a vertical axis for diabetes incidence rates, and a horizontal axis for latitude. The latitudes range from -60 for the southern hemisphere, to zero for the equator, to +70 for the northern hemisphere. They then plotted incidence rates for 51 regions according to latitude. The resulting chart was a parabolic curve that looks like a smile.

In the paper the researchers call for public health action to address widespread vitamin D inadequacy in U.S. children.

"This study presents strong epidemiological evidence to suggest that we may be able to prevent new cases of type 1 diabetes," said Garland. "By preventing this disease, we would prevent its many devastating consequences."

The study was published June 5, 2008 in the online version of the scientific journal Diabetologia.

Children Still At Risk from Lead Poisoning, Despite Programs Promoting Cleaning and Home Repair

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A review of studies shows that children are still at risk of lead poisoning, despite attempts to encourage home cleaning and repairs, and parental awareness.

Lead author Dr. Berlinda Yeoh, a pediatrician at Sydney Childrens’ Hospital in New south Wales, Australia, says of these attempts that "none that have been tried so far have been proven to be effective." The most common cause of lead poisoning in children is ingestion of dust from old lead paint, and Dr. Yeoh cited lead poisoning as an important health issue for children. It can, she said, contribute to behavior and growth problems, anemia, kidney damage, and other physical, cognitive and behavioral impairment.

Although the sale of lead paint in the United States was prohibited as long ago as 1978 children today can still ingest paint from peeling walls, broken plaster or old painted window sills. 12 U.S. studies, encompassing 2239 children, were examined, and analyzed 2 types of parental interventions—educational and environmental. Educational intervention taught awareness of lead poisoning and methods of preventing dust and lead exposure in the home; environmental intervention suggested making repairs, cleaning and painting.

The Cochrane Library carried the review, and the reviewers’ findings that educational programs for parents had no effect on children’s blood lead levels, which was also the case for environmental programs. Soil abatement, or the replacement of lead-contaminated soil around the home, was also analyzed and 2 studies showed that this significantly reduced childrens’ blood lead levels, although insufficient data prevented recommending these practices as effective. Even studies that combined both educational and environmental interventions failed to reduce children’s blood lead levels.

Dr. Yeoh pointed to other sources of lead exposure—at day care or relatives’ home, for example—which might make home dust removal programs ineffective.

A further reason might be lack of time to be cleaning thoroughly, said Dr. Yeoh. Based on these results, "it is difficult to support the use of the interventions examined in this review as a general population health measure, given their cost and the lack of data showing positive reductions in blood lead levels," the authors said.

Susan Buchanan, M.D., a clinical assistant professor at the University of Illinois at Chicago School of Public Health, called the review "a very thorough evaluation of current literature. It takes so little lead dust to poison a child that it doesn’t matter how clean your house is, your child is still going to have exposure to lead dust," she said.

"As adults, our neurological systems are somewhat immune to the dramatic effects of lead," Buchanan said. However, very young children often put objects in their mouths—increasing their ingestion of house dust and dirt—that in turn affects their developing neurological systems, she said.

"We have to use the knowledge we have—there is lead in dust, so as much dust removal as possible should still be recommended," she said. However, to "continue screening is critical because if high blood lead levels are caught, then health department inspectors can be used to point out obvious sources of lead in the home," Buchanan said.

The review noted that a coauthor, Bruce Lanphear, was an investigator in two of the studies included in this review.

Source: Health Behavior News Service

New Study Begins for Kids with High Risk Cancer, Neuroblastoma

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Molecular Insight Pharmaceuticals has announced the initiation of a clinical trial of Azedra in pediatric neuroblastoma patients. Neuroblastoma is a type of neuroendocrine cancer that primarily affects children and is the most common solid tumor in children outside of the brain.

The drug Azedra is a small, targeted radiotherapeutic molecule that binds to the norepinephrine transporter, a protein highly expressed on neuroendocrine tumors such as neuroblastoma. Because of this preferential binding, Azedra can deliver a greater amount of radiation to the tumor cell, thus increase tumor killing while reducing side effects.

“Neuroblastoma is an aggressive and difficult to treat form of neuroendocrine cancer that usually affects children under five years of age,” said Katherine Matthay, M.D., Chief of Pediatric Hematology and Oncology at the University of California San Francisco Children’s Medical Center. “Unfortunately, the prognosis for many of these children is quite poor. There currently are no FDA-approved treatments available for patients who have progressive, recurrent or refractory disease, and our current treatment options are extremely limited.”

What Can Birds Teach Us About Raising Our Own Young?

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Are younger siblings at a competetive disadvantage to their older brothers or sisters? What wisdom can a bird study provide to us about human sibling relationships?

Common wisdom holds that the first-laid birds in a clutch have a better chance of surviving to leave the nest. But Keith Sockman, an assistant biology professor in UNC’s College of Arts and Sciences, has discovered that first-laid eggs are, in fact, the least likely to hatch at all. His findings, based on studying a population of Lincoln’s sparrows in a remote stretch of Colorado’s San Juan Mountains, were published in the March 12,2008 issue of PLoS ONE. "I believe this is the first study to follow siblings from laying through fledging and demonstrate that the effect of laying order on hatching is very different from its effect post-hatching," said Sockman.

It is well-known that because the youngest hatchlings are too small to compete with their stronger brood-mates for the food provided by their parents, they often die. This pattern is often repeated in other animals, from beetles to marsupials to humans. But these observations have so far not allowed for whathappens to eggs before they hatch.

Female Lincoln’s sparrows usually produce three to five eggs, laying one egg a day. Monitoring the birds for three breeding seasons, Sockman and his researchers noticed that the mothers did not start incubating the eggs right away, since they had other things claiming their attention, such as foraging for food. Sockman thinks this makes it probable that first-laid eggs won’t hatch at all, besides helping ensure that a greater number of healthy, strong birds will hatch and mature into young birds.

"At these elevations, conditions can be fairly harsh even during the summer when Lincoln’s sparrows breed," said Sockman. "It’s often freezing at night, which is hard on an un-incubated egg, while daytime temperatures are warm enough to foster the growth of harmful microbes. As a result, since the mother sparrow isn’t keeping them at the most optimal incubating temperature from day one, first-laid eggs can be exposed to environmental conditions that lower the chance those embryos will ever see the world outside their shell."

"If the female did start incubating all her eggs as soon as she laid them, it would increase the probability they’d all hatch. But it would also give a huge head start to those first-laid eggs and the chicks that emerge from them, putting their younger siblings at even more of a competitive disadvantage once they begin battling for food and their mother’s attention," said Sockman.

"It may also reduce the number of eggs she is capable of laying.The mother’s careful balancing of this trade-off enables her to end up with three or four relatively equally robust offspring, instead of one or two strong hatchlings and several "runts of the litter."

Sockman plans to examine what, if any repercussions laying order has once young birds reach adulthood. "The severely competitive environment in the nest may have consequences on the individual’s ability to compete for resources and mates the following year when it is reproductively mature," said Sockman.

Keep these findings in mind as you raise your own young!

Not Enough Doctors to Treat Increasing Number of Obese and Diabetic Children

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The number of diabetic and obese children is growing so rapidly that there aren’t enough doctors to treat the kids. According to a recent study by University of Michigan’s C.S. Mott Hospital, there is only one board-certified pediatric endocrinologist per 290 children with diabetes. The ratio of obese children to board-certified endocrinologists is 17,000 to 1. The rate if childhood obesity in the United States meanwhile has more than doubled in the past 20 years, with a corresponding increase in the number of children at risk for type 1and type 2 diabetes.

"Although the American Diabetes Association recommends that all children with diabetes be cared for by a pediatric endocrinologist as part of a diabetes team, there is a current shortage of pediatric endocrinologists in this country," says study lead author Joyce Lee, M.D., MPH, a pediatric endocrinologist and member of the Child Health Evaluation and Research (CHEAR) Unit in the U-M Division of General Pediatrics. "This problem will likely only worsen due to the recent epidemic of childhood obesity."

The 16.5% of American children aged 6 to 19 who are obese are at risk for ‘adult’ diseases such as type 2 diabetes, elevated blood pressure and high cholesterol. As a result more children than ever are being referred to pediatric endocrinologists for screening, evaluation and management. "But even if just a small fraction of obese children are referred to a pediatric endocrinologist for evaluation", says Lee, " the overall ratio of one pediatric endocrinologist to 17,000 obese children makes providing the necessary care extremely challenging." Dr. Lee is assistant professor in the Department of Pediatrics and Communicable Diseases at the U-M Medical School.

Available pediatric endocrinologists are so few in relation to the number of children at risk that they cannot see even a fraction of the children with diabetes or at risk for the disease. "The epidemic of childhood obesity has undoubtedly created new challenges for our health care, and we need to reassess the current system to ensure children with diabetes or at risk for diabetes receive appropriate care," Lee notes.

Pediatric endocrinologists currently do not have the capabilities to see even a fraction of the large number of children with diabetes or at risk for diabetes. "The epidemic of childhood obesity has undoubtedly created new challenges for our health care, and we need to reassess the current system to ensure children with diabetes or at risk for diabetes receive appropriate care," Lee notes.

Using data from the American Board of Pediatrics and the National Survey of Children’s Health, Lee and her colleagues compared the number of board certified pediatric endocrinologists by region to obese children and children with diabetes in those same areas.

Their research revealed that there are an estimated 229,249 children with diabetes, and only 790 board-certified pediatric endocrinologists in the country. And, in two states—Montana and Wyoming—there are no board-certified pediatric endocrinologists.

The study was published in the March, 2008 issue of The Journal of Pediatrics.