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Drinking While Pregnant Still a Problem

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Exposure to alcohol is a known cause of birth defects, yet the number of women who drink alcohol while pregnant is not decreasing, according to a 15 year-study by the Centers for Disease Control and Prevention. Approximately 1 in 8 women drank any amount of alcohol while pregnant, the study says.

The drinking patterns persisted despite repeated warnings from surgeons general about the dangers of drinking alcohol while pregnant. The surgeons general have told pregnant women, and women who may become pregnant to abstain from alcohol consumption in order to eliminate the chance of giving birth to a baby with alcohol related birth defects.

The CDC analysis, as well as a study also published today by the U.S. Substance Abuse and Mental Health Services Administration shows that far too many women use substances (especially alcohol) during their pregnancies.

The CDC study, “Alcohol Use Among Women of Childbearing Age, United States, 1991-2005,” is in the CDC′s Morbidity and Mortality Weekly Report.

The CDC study also found that 1 of every 50 pregnant women engaged in binge drinking each year during the 15 years.

“Exposure to alcohol can cause lifelong physical and mental disabilities that are preventable by avoiding alcoholic drinks while pregnant,” said Edwin Trevathan, director of the CDC′s National Center on Birth Defects and Developmental Disabilities. “All women should know that there is no known safe amount of alcohol to drink or safe time to drink it during pregnancy. We encourage all women to pay attention to the surgeon general warnings.”

The study found that pregnant women most likely to report any alcohol use were 35-44 years of age (17.7 percent), college graduates (14.4 percent), employed (13.7 percent), and unmarried (13.4 percent). Pregnant women who binge drink were more likely to be employed and unmarried than were pregnant women who did not binge drink. This study did not examine the reasons why women are still drinking while pregnant.

Any alcohol use was defined as at least one drink of any alcoholic beverage in the past 30 days. Binge drinking was defined as having five or more drinks on at least one occasion in the past 30 days.

“By screening and advising women about the risks of drinking while pregnant, health care providers can play a key role in reducing rates of fetal alcohol syndrome,” said Clark Denny, a CDC epidemiologist and primary author of the study. “This study revealed that there is still a great need for health care professionals to routinely ask all women who are pregnant or at risk of being pregnant about their alcohol consumption.”

The study examined data from 533,506 women aged 18-44 years, of whom 22,027 reported being pregnant at the time of the interview. The data were obtained from the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is a state-based system of health surveys that collects information on health risk behaviors, preventive health practices, and health care access primarily related to chronic disease and injury. Data are collected monthly in all 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and Guam.

source: CDC, 5/21/09

Test Well Water Once a Year for Children’s Health

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Private well water should be tested yearly, and in some cases more often, according to new guidance offered by the American Academy of Pediatrics (AAP).

Researchers at the National Institute of Environmental Health Sciences (NIEHS), part of the National Institutes of Health, took a lead role in working with the AAP to develop these recommendations and draft a new AAP policy statement about the things parents should do if their children drink well water. The recommendations call for annual well testing, especially for nitrate and microorganisms such as coliform bacteria, which can indicate that sewage has contaminated the well.

The recommendations point out circumstances when additional testing should occur, including testing when there is a new infant in the house or if the well is subjected to structural damage.

“Children are especially vulnerable to waterborne illnesses that may come from contaminated wells,” said Walter J. Rogan, M.D., an epidemiologist at NIEHS and lead author on the policy statement and technical report that appears in the June issue of Pediatrics. The new policy statement, “Drinking Water from Private Wells and Risks to Children,” offers recommendations for inspection, testing and remediation of wells providing drinking water for children.

“With few exceptions, well owners are responsible for their own wells,” said Rogan. Private wells are not subject to federal regulations and are only minimally regulated by states. With proper care, well water is safe; however, wells can become contaminated by chemicals or pathogenic organisms.

Nitrate, which comes from sewage or fertilizer, is the most common contaminant in wells. The presence of nitrates can be a problem particularly for infants under three months who can not metabolize nitrate. Water with a nitrate concentration of more than 1.0 milligrams per liter should not be used to prepare infant formula or given to a child younger than one year. The policy statement suggests using bottled water for infants when nitrate contamination is detected, or when the source of drinking water is not known.

The policy statement and accompanying technical report point out that water contamination is inherently local, and that families with wells need to keep in contact with state and local health experts to determine what should be tested in their community. For example, some parts of the country may have arsenic, radon, salt intrusion or agricultural runoff that may get into the water supply.

“As people move out of urban and suburban areas into areas that are not reached by municipal water supplies, it is more important than ever that people know who to contact in their local health department to get information about local groundwater conditions,” said N. Beth Ragan of NIEHS, who served as consultant on these reports. A compilation of state by state telephone and Web-based resources of local experts is included in the technical report. Approximately one-sixth of U.S. households now get their drinking water from private wells.

NIEHS Director Linda Birnbaum, Ph.D., says she is pleased that NIEHS researchers took the lead in writing this statement, and continue their longstanding liaisons with the American Academy of Pediatrics to develop state-of-the-science technical reports that can have a direct impact on public health.

“This statement will be extremely useful to many audiences — especially pediatricians,” Birnbaum said. “Pediatricians needed a one-stop shopping document that they can share with parents who have concerns about their children�s sources of drinking water.”

Source: NIH, May 26, 2009

Pool Chemical Injuries Threaten Thousands

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Pool chemical injuries account for as many as 5,200 emergency room visits each year. A new study by the Centers for Disease Control and Prevention shows that these injuries are preventable, and during 2007 almost half of those injuries occurred at a residence.

According to the study, published in CDC′s Morbidity and Mortality Weekly Report (MMWR), persons can be injured by inhaling fumes when they open pool chemical containers, attempting to pre-dissolve pool chemicals, or handling them improperly. Persons can also be injured when chemicals splash into the eyes. These preventable injuries typically occur during the summer swimming season, from Memorial Day to Labor Day, and can occur in or out of the pool.

In addition to pool chemical injuries, thousands of people each year suffer from recreational water illnesses. The study was released ahead of CDC′s National Recreational Water Illness Prevention Week, May 18-24. The week aims to raise awareness about healthy swimming behaviors, including ways to prevent recreational water illnesses and injuries. Recreational water illnesses are illnesses spread by swallowing, inhaling vapors, or having contact with contaminated water in swimming pools, water parks, spas, interactive fountains, lakes, rivers, or oceans.

“Pool chemicals make the water we swim in safer by protecting us from germs, but these same chemicals can also cause injuries if they are not properly handled,” said Michele Hlavsa, the study′s lead author and epidemiologist at CDC.

Public pool operators and residential pool owners can protect themselves and swimmers by always securing pool chemicals, reading product names and manufacturer′s directions before each use, using appropriate protective gear including safety glasses and gloves, and never mixing chlorine products with each other, with acid, or with any other substance.

The study looked at 36 pool chemical-associated health events reported to the New York state Department of Health for recreational water venues, such as pools, water parks, and interactive water fountains, during 1983-2006.

Swimming is the second most popular sports activity in the United States, with approximately 339 million swimming visits to recreational water venues.

The best way to prevent recreational water illnesses is to keep germs out of the pool in the first place. Everyone can help create healthy swimming experiences by not swimming when ill with diarrhea, not swallowing pool water, taking kids on bathroom breaks and practicing good hygiene.

Source: CDC, May 23, 2009

Experimental Therapy Uses Body’s Immune System to Increase Cure Rate in Neuroblastoma Patients

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A multicenter research team has announced encouraging results for an experimental therapy using elements of the body’s immune system to improve cure rates for children with neuroblastoma, a challenging cancer of the nervous system.

John M. Maris, M.D., chief of Oncology at The Children’s Hospital of Philadelphia, co-authored the phase 3 clinical trial, which was led by Alice Yu, M.D., Ph.D., of the University of California, San Diego. Maris chairs the committee supervising the trial for the Children’s Oncology Group, a cooperative organization that pools resources from leading medical centers to study and devise new treatments for pediatric cancers.

Neuroblastoma, a cancer of the peripheral nervous system, usually appears as a solid tumor in the chest or abdomen. Neuroblastoma accounts for 7 percent of all childhood cancers, but due to its often aggressive nature, causes 15 percent of all childhood cancer deaths.

Yu will present the neuroblastoma study results on June 2 at the annual meeting of the American Society of Clinical Oncology (ASCO) in Orlando, Fla. In advance of the meeting, ASCO published the findings online on May 14.

Maris explained that immunotherapy for cancer involves triggering the body’s immune system to attack cancer cells. Monoclonal antibodies are molecules customized to target particular cancers, while cytokines are naturally occurring signaling proteins that regulate the body’s immune responses.

In the current study, Children’s Oncology Group researchers studied 226 children with high-risk neuroblastoma. Half received the immunotherapy, while half received standard therapy (chemotherapy and stem cell transplantation). The patients who received the immunotherapy were 20 percent more likely than those in the standard therapy group to live disease-free two years after treatment. “This 20 percent improvement in preventing relapse led to a greater cure rate—the first substantial increase in cure rate for neuroblastoma for more than a decade,” said Maris.

The researchers halted the trial earlier than expected after early results showed the benefits of immunotherapy. “This experimental immunotherapy is poised to become part of the new standard of care for children with the aggressive form of neuroblastoma,” said Maris.

Maris added that the supply of the antibodies and cytokines used in the trial was limited, and that pediatric oncologists were seeking biotechnology companies to move the biological agents into commercial production to make the treatment readily available to children with neuroblastoma.

The Children’s Hospital of Philadelphia has one of the nation’s largest clinical and research programs in neuroblastoma. In 2008, Maris led a study that was the first to identify the gene location at which neuroblastoma originates. His laboratory continues to investigate how genes contribute to the disease, using that knowledge to devise new treatments.

Maris served as an oncologist for Alex Scott, the child with neuroblastoma who started a lemonade stand in 2000 to raise money for programs in childhood cancer. Now operated through the Scott family, the Alex’s Lemonade Stand Foundation supports ongoing research by members of the Children’s Oncology Group.

Source: American Society of Clinical Oncology, May 14, 2009

Cough and Cold Medicines for Kids

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As we approach the cold weather, you may see your kids sniffling more, having sore throats and stuffy noses.

Choosing the appropriate remedy from a wide variety of over-the-counter medications is an important choice for parents. Over the past year there has been a lot of communication about whether or not these products should be used to treat children. The rules for marketing many of these products were developed many years ago. These rules do not always require that the products be studied in children to show whether they work for children but instead allow conclusions from experience of their effectiveness in adults.

My Take is that we must now understand scientifically that children are not just little adults. Current scientific standards must be used to assure these medications are effective and safe for your children in the correct prescribed dose to treat your child’s cough and cold.

FDA has been gathering information on these products, and we have held two public meetings with stakeholders. Thus far, we have recommended that these products not be used in children under the age of two because of concerns about serious and potentially life-threatening side effects.

In the meantime, manufacturers are taking voluntary actions. Some have announced that they will change the labeling of these products to include the statement “do not use” in children under four years of age. Manufacturers are also introducing other ways to help better inform consumers and to prevent misuse – such as new child-resistant packaging and new measuring devices for use with these products.

One thing is for certain: we must not give children medication labeled only for adults. And, when deciding on the right doses for children we need to rely on modern scientific standards.

While the FDA works to gather data and revise the labeling of certain ingredients and dosing for cough and cold products for children, please consult with your doctor or pharmacist with your particular questions about the use of these medications for your child or grandchild.

Andrew C. von Eschenbach, M.D.
Commissioner of Food and Drugs (FDA)

Landmark Research Into Child And Maternal Health Expanded

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A landmark research study into childrens’ health, the National Childrens’ Study, will now add the St Louis area. Researchers will monitor children from Jefferson County in Missouri and Johnson, Union and Williamson counties in southern Illinois from before birth to age 21 to learn more about environmental and genetic influences on diseases.

Saint Louis University School of Public Health was awarded a $26.3 million contract from the National Institutes of Health, the Centers for Disease Control and Prevention (CDC) and the U.S. Environmental Protection Agency.

“Families in Jefferson County and southern Illinois will have an opportunity to be on the forefront of landmark research into child and maternal health,” says Terry Leet, Ph.D., lead investigator of the Jefferson, Johnson, Union and Williamson counties study sites and chairman of the department of community health at Saint Louis University School of Public Health. “Ultimately, what we find will benefit all Americans because we will gain information to help develop strategies to prevent disease, design health and safety guidelines and possibly find new treatments and cures for diseases.”

Saint Louis University School of Public Health was awarded a $26.8 million contract last year to monitor the health of children from St. Louis City and Macoupin County in Illinois, and the research team will enroll participants from those areas in 2010.

Dr. Leet, who was recently appointed to serve on the executive steering committee of the National Children’s Study, is lead investigator of both sets of study sites. This appointment acknowledges his national expertise in maternal and child health.

The four Missouri and Illinois sites form the region’s Gateway Study Center. Partnering institutions are Saint Louis University School of Medicine; Southern Illinois University Edwardsville School of Nursing; Southern Illinois University School of Medicine; Washington University School of Medicine; Southern Illinois University Carbondale’s Center for Rural Health and Social Service Development; and Battelle Memorial Institute.

Factors affecting a child’s health before it is born will be followed, and information about diet and exposure to chemicals and other substances in the environment and emotional stress.will be obtained from pregnant women or women likely to become pregnant.

“Recruiting mothers before conception, or in very early pregnancy, means we can measure environmental influences when the fetus is first forming. We have limited knowledge currently but we know that early exposures can have lifelong effects on metabolism and risk of chronic disease in adulthood,” said Louise Flick, DrPH, co-principal investigator and professor of nursing from Southern Illinois University Edwardsville School of Nursing.

Once the child is born, researchers will collect air, water and environmental samples from where children spend most of their time. They will analyze fingernail, hair, blood and urine samples and screen for birth defects, injury susceptibility, physical and mental disorders, asthma, diabetes and obesity, among other conditions.

“Our research will give scientists access to a vault of information that could ensure a healthier future for generations to come,” Leet says. “What we find could have huge implications for the health of our children and their children’s children.” “Large population-based studies are best suited by institutions with overlapping, yet distinct skills,” said Allison King, M.D., assistant professor of pediatrics and of occupational therapy at Washington University School of Medicine in St. Louis and co-principal investigator of the study. “We are lucky enough to have several strong institutions in the area that complement each other.”

The National Children’s Study will be conducted in 105 locations across the country. During the last two years, Congress has appropriated a total of $179.9 million to support the project.

Frequency of Eating Candy, Not Amount, Increases Risk of Cavities

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According to Temple University pediatric dentist Mark Helpin it’s the frequency of eating candy, not the amount, that increases the risk of cavities. So when her daughters go trick or treating, Megan Chiplock lets them eat as much as they want.

“We let them go at it, gorge themselves, and maybe for a few days after if they want a piece here and there,” she says. “But they really get their fill on Halloween night, and [then] it’s sort of out of their system.” “The frequency of eating candy, and other refined carbohydrates, and their stickiness, are big factors in creating the risk of caries (cavities),” adds. Mark Helpin.

The pH balance in the mouth can be changed by eating carbohydrates. The resulting increase in acidity can increase the risk of cavities, and each time someone eats candy it can take an hour for the acid environment in the mouth to dissipate.

“So, if I eat a piece of candy now, the pH in my mouth will become acidic, and it will take 30-60 minutes for it to become normal,” said Helpin. “If I keep eating candy throughout the day, there is acid in my mouth for a much longer period of time. The longer teeth are in an acid environment, the greater the risk they will become decayed.”

There are several ways that parents can allow kids to enjoy the holiday, and still minimize the risk, says Helpin, the acting chair of Pediatric Dentistry at Temple’s Maurice H. Kornberg School of Dentistry. “Parents can let kids eat a bunch [of candy] now and a bunch later. But don’t let them have one piece now, then an hour later let them have another piece,” he said, adding that candy can also be dispensed as a dessert or snack. Treats as dessert at mealtimes? Good idea, says Helpin, because the production of saliva increases and that helps wash away oral acidity. Brushing teeth immediately after eating candy is recommended by Helpin, or at least rinsing out the mouth with water 3 or 4 times after eating, again to reduce acidity in the mouth.

Helpin warns that substituting small bags of chips or pretzels for candy doesn’t solve the cavity problem, either. “Chips and pretzels are also carbohydrates and they also will create an acid environment that can create cavities,” he says. “These treats and snacks get stuck on your teeth, and that’s the stickiness factor,” he said.

At trick or treat time, Helpin avoids sticky candies in favor of sugar-free varieties. Ultimately, “it’s not realistic to think you can tell your child you can’t have candy, cookies, cakes, or other treats,” says Helpin. “Those are the things most people enjoy—and we want our kids to enjoy life.”

Pregnant Moms: Eat Your Fish, It’s Good For Baby, So Is Longer Breastfeeding

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A study of Danish mothers and infants finds that infants benefit from physical and cognitive development when the mother eats fish when pregnant. Longer breastfeeding also benefits baby.

Fears of mercury levels in fish have led to American women being advised to keep their fish consumption to a minimum, but this study recommends that pregnant women eat low-mercury fish—cod, plaice, salmon, herring and mackerel—at least three times a week. Additionally, the study reinforces existing evidence that breastfeeding is beneficial to an infant’s development.

“These results, together with findings from other studies of women in the U.S. and the United Kingdom, provide additional evidence that moderate maternal fish intake during pregnancy does not harm child development and may on balance be beneficial,” said Assistant Professor Emily Oken, lead author of the study.

Researchers from the Department of Ambulatory Care and Prevention of Harvard Medical School and Harvard Pilgrim Health Care and the Maternal Nutrition Group from the Department of Epidemiology at Statens Serum Institut in Copenhagen, Denmark, conducted the study. It was published in the September issue of American Journal of Clinical Nutrition and confirmed that the omega-3 fatty acids in fish, and breast milk compounds benefit infant development.

The study reviewed 25,446 children born to pregnant women enrolled from 1997—2002 in the Danish Birth Cohort. Participants were asked about child development markers at 6 and 9 months postpartum, and breastfeeding at 6 months postpartum. Prenatal diet, including amounts and types of fish consumed weekly, was assessed by a detailed food frequency questionnaire administered when they were six months pregnant.

Mothers were asked about their infants’ specific physical and cognitive development markers at 6 months, eg. holding up his/her head, sitting with a straight back, sitting unsupported, responding to sound or voices, imitating sounds, or crawling. More advanced markers were checked at 18 months – could the child hold up his/her head, sit with a straight back, sit unsupported, respond to sound or voices, imitate sounds, or crawl.

The children whose mothers ate the most fish during pregnancy were more likely to have better motor and cognitive skills. For example, among mothers who ate the least fish, 5.7% of their children had the lowest developmental scores at 18 months, compared with only 3.7% of children whose mothers had the highest fish intake. Compared with women who ate the least fish, women with the highest fish intake (about 60 grams—2 ounces—per day on average) had children 25% more likely to have higher developmental scores at 6 months and almost 30% more likely to have higher scores at 18 months.

Longer duration of breastfeeding was also associated with better infant development, especially at 18 months. Breastmilk also contains omega-3 fatty acids. The benefit of fish consumption was similar among infants breastfed for shorter or longer durations.

“In previous work in a population of U.S. women, we similarly found that higher prenatal fish consumption was associated with an overall benefit for child cognitive development, but that higher mercury levels attenuated this benefit,” says Dr. Oken. “Therefore, women should continue to eat fish—especially during pregnancy—but should choose fish types likely to be lower in mercury.” Information on mercury levels in commonly consumed fish is available at the U.S. Food and Drug Administration website.

Source: American Journal of Clinical Nutrition, September, 2008

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