Health Briefs…Through the Years

by Stacey

Lots of good stuff from the November issue of the Journal Pediatrics.

Let’s start with the babies. One new study called Are We Overprescribing Antireflux Medications for Infants With Regurgitation? shows that babies who are treated with drugs for gastroesophageal reflux disease, or GERD, may not actually need the medication. According to the study abstract, “The majority of infants who were prescribed antireflux drugs did not meet diagnostic criteria.”

Researchers conducted esophageal pH monitoring (measuring the reflux or regurgitation of acid from the stomach into the esophagus) of 44 infants in a New Orleans medical center. Each of the children had persistent regurgitation. The study showed that while only eight of the infants had abnormal pH levels indicating GERD, 42 of 44 infants were on antireflux medication. When medication was withdrawn from the infants who did not meet GERD criteria, reflux symptoms did not worsen.

My son Sage was a “persistent regurgitator” as an infant. Oh, he regurgitated all over the place. On me, on himself, on the floor, on the furniture, on the airplane, you get my drift. It was a mess. Our pediatrician diagnosed him with reflux, but since it wasn’t the painful kind, he didn’t mention anything about treating him. I’m glad too, because what did I know? Probably if he had told me that Sage needed medicine for his constant barfing I would have given it to him. Do no harm, doctors, do no harm.

Now on to the little guys. Another study called, Early Violent Television Viewing Associated with Later Anti-Social Behavior, found a link between violent television viewing by preschool boys (ages 2 to 5) with antisocial behavior at ages 7 to nine.

According to the study abstract, researchers reviewed data from the Panel Study of Income Dynamics (a nearly 40-year study of 8,000 U.S. families) on 184 boys and 146 girls. The data review found a link between pre-school-age boys watching violent programming and antisocial behavior at ages 7 to 9. There was no link found between non-violent television viewing and antisocial behavior in boys or girls, or violent programming and anti-social behavior in girls. The study authors say the findings are significant as early childhood aggressive behavior is often a predictor of violent behavior in youth and adolescents.

I couldn’t make my way online to the full text of the article so I’m not sure what violent TV means or what defines antisocial behavior. Neither sound good. Sage doesn’t watch “tough movies” as he calls them. But his imaginary friend Hippy does. According to Sage, Hippy likes “the punching kind.” Yikes. I just hope Hippy’s parents are prepared to deal with the fallout.

And finally, a new study entitled Shorter Sleep Duration Is Associated With Increased Risk for Being Overweight at Ages 9 to 12 Years, found that kids this age who did not get enough sleep were more likely to be overweight by sixth grade. According to the study abstract, shorter sleep duration in 6th grade was independently associated with a greater likelihood of kids being overweight. Shorter sleep duration in 3rd grade was also independently associated with being overweight in 6th grade, independent of the child’s weight status in 3rd grade.

Conversely, for every additional one hour of sleep in 6th grade, a child was 20 percent less likely to be overweight in 6th grade; every additional hour of sleep in 3rd grade resulted in a 40 percent decrease in the child’s risk of being overweight in 6th grade.

For me sleep deprivation translates into energy deprivation which I try to make up for by eating sugar. I can’t believe the sweets I pack away when my kids’ sleep is chronically interrupting my own. Maybe that’s what’s going on. Or maybe the kids in this study were squirreling away boxes of cookies that they ate in the middle of the night by flashlight under the covers. After the insanity I’ve witnessed around here over Halloween candy, I’ll believe anything.

Closet Co-Sleepers

by Stacey

Nearly 13 percent of parents in the U.S. practiced co-sleeping with their children in 2000 up from 5.5. percent in 1993, according to a series of studies on co-sleeping published in the August issue of the journal Infant and Child Development. And according to this article in the NY Times, the current number may actually be much higher.

Ask parents if they sleep with their kids, and most will say no. But there is evidence that the prevalence of bed sharing is far greater than reported. Many parents are “closet co-sleepers,” fearful of disapproval if anyone finds out, notes James J. McKenna, professor of anthropology and director of the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame.

“They’re tired of being censured or criticized,” Dr. McKenna said. “It’s not just that their babies are being judged negatively for not being a good baby compared to the baby who sleeps by himself, but they’re being judged badly for having these babies and being needy.”

Pediatricians generally frown on co-sleeping. The American Academy of Pediatrics has said babies should sleep close to their parents but not in the same bed, the article says. The concern is that a sleeping parent could trap a baby in bed covers or in the space between the bed and the wall.

Although some studies suggest bed sharing puts children at higher risk for sudden infant death syndrome, the data are not conclusive. And some researchers say the risk is higher only if parents smoke, drink too much alcohol and fail to take proper precautions to make sure the bed is safe.

Others raise concerns that children will not develop healthy sleep habits or that marriages will suffer if children sleep between parents. In one study, for example, 139 parents were asked about the sleep habits of their young children. Parents who slept with their children reported a much higher frequency of nighttime wakings than parents who did not. But experts say that kids who sleep solo may have night wakings, it’s just that parents don’t know about it. The crux is whether the co-sleeping parents consider night wakings a problem.

As for the toll it takes on marriages, co-sleeping causes trouble if the couple is not in agreement about the arrangement, the article says. Otherwise, couples report equal levels of happiness in their relationship as couples who do not co-sleep.

There are intentional co-sleepers — those who sleep with their children because they want to breast-feed for a long stretch and believe bed sharing is good for a child’s well-being and emotional development. Another group is reactive co-sleepers, those parents who don’t really want to sleep with their kids, but do so because they can’t get their children to sleep any other way or because financial hardship requires them to share a room with a child.

And then there is a third group that she tentatively calls circumstantial co-sleepers — parents who sleep with their children occasionally because of circumstances like sharing a bed on a family vacation, during a thunderstorm or because the child is sick.

Problems occur most often among reactive co-sleepers, the article says, because the situation feels coerced.

My family falls into that third group, the circumstantial co-sleepers. For the most part I like sleeping with my kids. It’s cozy and sweet. But I think if we did it all the time, we’d need to get a bigger bed. The writer of the article says sleeping with kids is like sleeping inside a washing machine and she has a point. All that twisting and kicking. Oy.

By the way, I’m all for people coming out of the closet. If anyone wants to do so here on Fussbucket, feel free.

Sleep Smarts

by Stacey

As a parent of two very young children, I obsess over sleep. I read books about it, I avoid activities during the day so my kids can get it, and I long for the days when I got enough of it. According to this article in New York magazine, I would be smart to hold fast to my obsession until my kids are out of high school. Apparently, sleep matters a lot not only to little kids and their desperately fatigued parents, but to elementary, middle school, and high school kids as well.

Studies show that kids from first grade to high school get about an hour less sleep each night than they did 30 years ago. Even kindergartners have lost a half hour in the last three decades. Life is busier than it used to be and working parents want to hang out with their kids before bedtime. “Until now, we could overlook the lost hour because we never really knew its true cost to children,” the article says.

Using newly developed technological and statistical tools, sleep scientists have recently been able to isolate and measure the impact of this single lost hour. Because children’s brains are a work-in-progress until the age of 21, and because much of that work is done while a child is asleep, this lost hour appears to have an exponential impact on children that it simply doesn’t have on adults.

This is interesting stuff. I never thought much about the effects of sleep deprivation until it became a way of life for me. Now I truly understand how a loss of sleep can lead you to forget where you live or where you parked your car at the mall. So it makes sense to me that it would have a big impact on children who are more sensitive and vulnerable than adults to everything else in life.

One study conducted by researchers at Tel Aviv University found that an hour difference in sleep between fourth graders led to a performance gap of two grade levels in school, which means a slightly sleepy sixth-grader will perform in class like a fourth-grader. “A loss of one hour of sleep is equivalent to [the loss of] two years of cognitive maturation and development,” Sadeh [the lead researcher] explains.

Dr. Paul Suratt of the University of Virginia studied the impact of sleep problems on vocabulary-test scores of elementary-school students. He found a seven-point reduction in scores. Seven points, Suratt notes, is significant: “Sleep disorders can impair children’s I.Q.’s as much as lead exposure.”

Studies show the effects of sleep loss on school performance are most pronounced among high school students. Studies of thousands of high school students show that even fifteen minutes of sleep can make a difference in grades earned in school.

Using functional MRI scans, researchers say that the brains of tired children have more trouble encoding memories, making it less likely that they will recall what they just learned. In addition, fatigue makes it more difficult for children to control their impulses and more likely they will become distracted from studying.

Not all of this is the fault of parents. In some school districts, the first bell rings early in the morning. Schools that have delayed the start of the school day have seen remarkable results in their students’ achievement.

The best known of these is in Edina, Minnesota, an affluent suburb of Minneapolis, where the high school start time was changed from 7:25 a.m. to 8:30. The results were startling. In the year preceding the time change, math and verbal SAT scores for the top 10 percent of Edina’s students averaged 1288. A year later, the top 10 percent averaged 1500, an increase that couldn’t be attributed to any other variable. “Truly flabbergasting,” said Brian O’Reilly, the College Board’s executive director for SAT Program Relations, on hearing the results.

The article also talks about the potential link between obesity and sleep loss in children. “All the studies point in the same direction: On average, children who sleep less are fatter than children who sleep more,” the article says. “This isn’t just in the U.S.; scholars around the world are considering it, as they watch sleep data fall and obesity rates rise in their own countries.”

Three foreign studies showed strikingly similar results. One analyzed Japanese elementary students, one Canadian kindergarten boys, and one young boys in Australia. They all showed that kids who get less than eight hours of sleep have about a 300 percent higher rate of obesity than those who get a full ten hours of sleep. Within that two-hour window, it was a “dose-response” relationship, according to the Japanese scholars.

I have to admit, there is a part of me that’s wondering if these are causal relationships. Perhaps there were other factors that led to the drop in academic performance or in the rate of obesity? I’m not totally convinced. But it’s good to know there’s the possibility and that maintaining good sleep habits for my kids is important. I certainly won’t be the one to underestimate the power of a good night’s rest. Those were the days…

Cold Meds No More

by Stacey

Last week, officials at the Food and Drug Administration urged parents to avoid giving common cold and cough medicines to young children. According to this AP story, the recommendation is “preliminary” as the agency awaits counsel by a panel of experts later this month.

The recommendation applies to decongestant use in children under 2, and antihistamines in those younger than 6, according to agency documents. The Centers for Disease Control and Prevention recently released a report that found more than 1,500 toddlers and babies wound up in emergency rooms over a two-year period because of the drugs.

Surprisingly, the Consumer Healthcare Products Association, which represents makers of over-the-counter medicines, backs the recommendation that the cold and cough treatments not be used in children younger than 2, the AP story says. Separately, for antihistamines, the group recommends adding a warning that the drugs not be used to sedate young children.

An FDA review of side-effect records filed with the agency between 1969 and September 2006, found 54 reports of deaths in children associated with decongestant medicines made with pseudoephedrine, phenylephrine or ephedrine. It also found 69 reports of deaths associated with antihistamine medicines containing diphenhydramine, brompheniramine or chlorpheniramine.

Most of the deaths were children younger than 2.

I heard about that CDC study on National Public Radio last spring and have already chucked all the cold meds for kids in our house. Last time Sage was coughing in his bed at night I made him some old-fashioned hot water with lemon and honey. He seemed to like it. I felt like a good mommy. Must be a placebo effect in there somewhere.

Crybabies

by Stacey

Despite what pediatricians have been telling beleaguered parents for years, colic may more than just a benign nuisance. “Few common afflictions of infancy may be as difficult to endure,” writes Dr. Jerome Groopman, the Recanti Professor at Harvard University in an article aptly entitled “Crybabies,” that appears in the Sept. 17 issue of The New Yorker.

“Here is something that has no known cause and no known treatment,” says Barry Lester, an expert on colic and a professor of psychiatry and pediatrics at Brown University. “What could be more frustrating? For years and years, the mantra from doctors has been ‘Bite the bullet.’ The fact is, this message to mothers is devastating.

Doctors don’t understand what causes colic, but they know it when they see it. They look for “The Rule of Threes”: crying by an otherwise healthy infant that lasts more than three hours a day, more than three days a week, for more than three weeks. As many as twenty per cent of American and European infants are thought to suffer from the condition, the article says.

Lester, who works with parents at the colic clinic at the Brown Center for the Study of Children at Risk, says that colic can leave a lasting impact on mothers and children. “At the center, we look at how colic is affecting not just the baby but the parent-infant relationship,” he says. “The crying will stop, but the relationship risks becoming disordered, and this can have a lasting effect on the child.”

Without help from doctors, parents of colicky babies often turn to parenting advice experts for help. In their book on attachment parenting, Dr. William Sears and his wife Martha advise parents to perform various maneuvers with their infants, including “the colic dance,” “the colic curl,” and “the ‘I Love U’ touch.” However, Groopman says there is little evidence that physical maneuvers can soothe a colicky infant, and “such advice may simply make exhausted parents who fail to follow it feel worse.”

Lester believes that some infants who suffer from colic are “hypersensitive to normal stimuli”: they perceive and react to changes in their bodies (such as hunger or gas pangs) or in their environment (such as loud noises or the experience of being touched) more acutely than do other babies, the article says. Lester speculates physical contact with parents is unlikely to soothe colicky babies, a theory that may be supported by data from societies in which babies are held continuously.

Ronald Barr, a professor at the University of British Columbia, has analyzed data gathered by Harvard researchers between 1969 and 1971, during a study of the !Kung San, a tribe of hunter-gatherers in Botswana who practice a version of attachment parenting. “We found that the !Kung San carry their babies upright, have skin-to-skin contact by day and night, breastfeed every 13.69 minutes for the first one to two years of life, and respond within fifteen seconds to any fret or whimper,” says Barr. “The duration of the crying is fifty per cent less among the !Kung San compared with Western babies, but the !Kung San still have what we call colic, with episodes of inconsolable crying.”

Other studies have shown similar results: Babies whose parents practice a version of attachment parenting do cry less, but among those groups, there are still babies who experience inconsolable crying. The attachment parenting method does not seem to work as a cure for colic.

Lester tells parents that, instead of going to their babies every time they cry, they need to teach their babies to soothe themselves, the article says. As he puts it, the infants must learn to “self-regulate.” Lester’s approach is practical rather than medical; he doesn’t claim to be able to cure colic. But, by giving parents permission to put their babies down, he is treating the family members who may be suffering most, Groopman writes.

The article says that some afflicted infants may be at risk of developing behavioral problems as children, in part, because colic affects the way parents interact with them as babies. “Colic threatens to cause problems in the child’s ability to form relationships, because the child doesn’t learn behavioral regulation and develops problems with impulse control,” Lester said. “It starts out with crying, and then, when the child is older, he doesn’t control his emotions very well.”

In his book, “Why Is My Baby Crying? The Parent’s Survival Guide for Coping with Crying Problems and Colic” (2005), Lester writes, “Our research, as well as plenty of others’ – had shown that these babies are more likely to have difficult temperaments and to experience feeding and sleeping problems…They can go on to have behavior issues in preschool and problems later on in school with attention/hyperactivity, sensory integration, and emotional reactivity.”

The article says there have been only few long-range studies of colicky infants. One comes from researchers at the University of Turku, in Finland. The study surveyed parents of children starting from three months until three years of age. Among the children, 338 infants had colic compared with 866 who did not.

The parents of previously colicky infants were found to be more dissatisfied with family life and the amount of time they had for both leisure and shared activities than were the parents of children who had not had colic. Mothers regarded the fathers’ contribution to the household as less adequate compared with the non-colic group, and their children, at the age of three, were more likely to sleep in their parents’ bedroom. Moreover, the three-year olds in the colic group had significantly greater difficulty falling asleep and more frequent temper tantrums. The Finnish researchers concluded that the children’s problems were likely related to behaviors that began during the period when the infant had colic and were not the result of the colic itself.

It just seems tragic that parents aren’t given more help when they are dealing with this. To be saddled with inconsolable crying right out of the gate is basically torture. I’m curious to know what parents who have had colicky babies think of this article. Is it breaking new ground?

mommy merit badge

by kristin

my 20 month-old, lily, broke her arm last week. well, actually, my friend fell on lily and broke her arm. so that has been a bummer for all three of us, as you can imagine.

yet, as we make our way through this latest challenge, i am once again reminded of my idea for mommy merit badges (TM). kind of like these old school camp fire girl badges you used to get for learning how to ride your bike or start a fire with sticks.

only my merit badges are for the moms.

say, for example:

your kid’s first broken bone

or this one:

diaper free

i earned this one just yesterday:

3 am wakeup five nights in a row

the possibilities are endless. we could sew (or glue or staple) them onto our diaper bags and give each other props at the playgound. wo-he-lo, mommies of the world. i salute you!