American Academy of Pediatrics weighs in for first time on organic foods for children

ScienceDaily (Oct. 22, 2012) — Parents know it's important for children to eat a wide variety of fruits and vegetables, low-fat dairy products, and whole grains. But it's less clear whether spending the extra money on organic foods will bring a significant benefit to their children's health.

To offer guidance to parents -- and the pediatricians caring for their children's health -- the American Academy of Pediatrics (AAP) has conducted an extensive analysis of scientific evidence surrounding organic produce, dairy products and meat. The conclusion is mixed: While organic foods have the same vitamins, minerals, antioxidants, proteins, lipids and other nutrients as conventional foods, they also have lower pesticide levels, which may be significant for children. Organically raised animals are also less likely to be contaminated with drug-resistant bacteria because organic farming rules prohibit the non-therapeutic use of antibiotics.

However, in the long term, there is currently no direct evidence that consuming an organic diet leads to improved health or lower risk of disease. No large studies in humans have been performed that specifically address this issue.

"What's most important is that children eat a healthy diet rich in fruits, vegetables, whole grains, and low-fat or fat-free dairy products, whether those are conventional or organic foods. This type of diet has proven health benefits," said Janet Silverstein, MD, FAAP, a member of the AAP Committee on Nutrition and one of the lead authors of the report. "Many families have a limited food budget, and we do not want families to choose to consume smaller amounts of more expensive organic foods and thus reduce their overall intake of healthy foods like produce."

The AAP report, "Organic Foods: Health and Environmental Advantages and Disadvantages," was released on Oct. 22 at the AAP National Conference & Exhibition in New Orleans. It will be published in the November 2012 issue of Pediatrics (published online Oct. 22). The report outlines the research that has been conducted on organic foods, including convincing evidence of lower exposure to pesticides and less contamination of livestock with drug-resistant bacteria.

"At this point, we simply do not have the scientific evidence to know whether the difference in pesticide levels will impact a person's health over a lifetime, though we do know that children -- especially young children whose brains are developing -- are uniquely vulnerable to chemical exposures," said Joel Forman, MD, FAAP, a member of the AAP Council on Environmental Health and one of the lead authors of the AAP clinical report.

If cost is a factor, families can be selective in choosing organic foods, Dr. Forman said. Some conventionally grown fruits and vegetables tend to have lower pesticide residues. The AAP cites organic shopper's guides like those provided by Consumer Reports and the Environmental Working Group as references for consumers. The AAP found no individual health benefit from purchasing organic milk, but emphasizes that all milk should be pasteurized to reduce the risk of bacterial infections. Raw milk increases the risk of serious infection with bacteria including Salmonella, E. coli, Listeria, Campylobacter and Brucella.

Purchasing meat from organic farms that do not use antibiotics for nontherapeutic uses has the potential to reduce antibiotic resistance in bacteria that infect people. The AAP calls for large, well-designed, prospective cohort studies that directly measure environmental exposures such as estrogen at low levels to understand the impact of hormonal exposure of children through milk and meat.

The AAP report also notes that the motivation to choose organic produce, meat and dairy products may be reasonably based on larger environmental issues, as well as human health impacts like pollution and global climate change.

"Pediatricians want families to have the information they need to make wise food choices," said Dr. Forman. "We hope that additional research will improve our understanding of these issues, including large studies that measure environmental exposures and neurodevelopment."

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The above story is reprinted from materials provided by American Academy of Pediatrics, via EurekAlert!, a service of AAAS.

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Journal Reference:

Joel Forman, Janet Silverstein, Committee On Nutrition and Council On Environmental Health. Organic Foods: Health and Environmental Advantages and Disadvantages. Pediatrics, 2012 DOI: 10.1542/peds.2012-2579

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Common risky behaviors of children struck by motor vehicles outlined

ScienceDaily (Oct. 19, 2012) — An abstract presented Oct. 19, at the American Academy of Pediatrics (AAP) National Conference and Exhibition in New Orleans highlights the risky behavior of child pedestrians who are struck by cars -- including darting into the street, crossing in the middle of the block, and crossing while using an electronic device.

For the abstract, "Risky Behaviors of Pediatric Pedestrians Who are Struck by Motor Vehicles," researchers collected data on all pedestrians who were injured by a motor vehicle and presented to a Level I trauma center in New York City between 2008 and 2011.

Of the 1,075 patients, 145 (13 percent) were under age 18. When compared with adults, children were more likely to be male (65 percent versus. 53 percent), have head injuries (82 percent versus 73 percent), and discharged without admission (70 percent versus 67 percent).

Children age 6 and younger were most often injured when darting into the street (44 percent) or crossing in the middle of the street (36 percent). For children ages 7 to 12, unsupervised activity accounted for 53 percent of the accidents, followed by mid-block crossing (47 percent) and darting into the street (25 percent). Among teens ages 13 to 17, 88 percent were struck by a motor vehicle while unsupervised, 32 percent while crossing mid-block, 18 percent while using an electronic device and 14 percent when darting into the street. Just 4 percent of the teen accidents involved alcohol use.

In comparison, 18 percent of the adult accidents were due to pedestrians crossing in the middle of the street, 15 percent to alcohol use and 9 percent to electronic device use.

"While most other research on this type of population looked only at discharge data of those admitted to hospitals, one of the strengths of this study is that it looks at all patients presented to the emergency department," said study author Nina E. Glass, MD. "While most of the young children in our study were supervised by a parent or guardian, these children still exhibited a lot of risky behaviors in terms of mid-block crossing and crossing against the signal."

In older children, there was a much higher incidence of using electronic devices,and listening to cellphones or music, than researchers saw in the adult population(18 percent of teens versus 9 percent of adults).

Dr. Glass said that greater parental supervision, and safety tip reminders by pediatricians, could play an important role in preventing child pedestrian accidents.

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Sharp rise in children admitted to hospital with throat infections since 1999

ScienceDaily (Oct. 19, 2012) — The number of children admitted to hospital in England for acute throat infections increased by 76 per cent between 1999 and 2010, according to new research published October 19 in Archives of Disease in Childhood.

Acute throat infection (ATI), which includes acute tonsillitis and acute pharyngitis, is one of the most common reasons for consulting a GP. The majority of ATIs are self-limiting and can be managed at home or by the GP, but a small proportion may require hospital admission.

This study investigated admission rates for children up to age 17 with ATI alongside trends in tonsillectomy rates, between 1999 and 2010. The study was motivated by concerns that the decline in tonsillectomy rates in recent years has led to an increase in hospital admissions for tonsillitis of increased severity. It also investigated whether performing fewer tonsillectomies is associated with higher rates of complications such as quinsy, an abscess that can occur when an infection spreads from a tonsil to the surrounding area.

The research, which was funded by a fellowship from the National Institute for Health Research, showed that the number of children admitted to hospital with ATI increased from 12,283 in 1999 to 22,071 in 2010 -- a rise in admission rate of 76 per cent. Short hospital stays, lasting less than two days, increased by 115 per cent over the decade, and accounted for the majority of admissions. Stays of two or more days in hospital for ATI decreased slightly, while quinsy rates remained stable. The authors found no evidence of an association between tonsillectomy trends and admission rates or the severity of ATI or quinsy.

The authors suggest that the dramatic increase in ATI admissions is probably explained by a large number of children being admitted for ATIs who would have formerly been managed in the community. The reasons for this may include changes in the provision of out-of-hours care in general practice and an increase in workload in Accident in Emergency departments. The four hour maximum waiting time in A&E, introduced in 2002, might have meant that doctors, who are under greater pressures, are more inclined to admit children to hospital with an ATI, the authors suggest.

Dr Elizabeth Koshy, from the School of Public Health at Imperial College London, who led the study said: "It is very concerning that there has been a major increase in hospital admissions for children with acute throat infections, particularly among those aged under five. We think this is likely to be due to problems at the primary care and secondary care interface. Our findings relating to short hospital stays suggest that many of the children admitted with acute throat infections could have been effectively managed in the community. Our study highlights the need to urgently address the issue of healthcare access, with improved models of integrated care within primary and secondary care, to avoid potentially unnecessary hospital admissions for relatively minor infections in the future."

Although these findings suggest that declining tonsillectomy rates do not appear to be associated with an increase in more severe ATI or quinsy rates, further research is needed to confirm this. Dr Koshy adds: "Tonsillectomy is a major and costly operation with potentially serious complications. So it seems sensible for clinicians to maintain a high threshold for referring children with recurrent throat infections for tonsillectomy and restrict it to those children who are most severely affected by these infections."

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Journal Reference:

E. Koshy, J. Murray, A. Bottle, P. Aylin, M. Sharland, A. Majeed, S. Saxena. Significantly increasing hospital admissions for acute throat infections among children in England: is this related to tonsillectomy rates? Archives of Disease in Childhood, 2012; DOI: 10.1136/archdischild-2012-301755

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Colorful Detergent 'Pods' a Danger for Children: CDC

By Steven Reinberg
HealthDay Reporter

THURSDAY, Oct. 18 (HealthDay News) -- Those bite-sized, brightly colored packets of concentrated liquid laundry detergent need to be kept out of the reach of small children, who often mistake them for candy, U.S. health officials warn.

Ninety-four percent of poisonings from these laundry detergent "pods" are among kids aged 5 and younger, a new report from the U.S. Centers for Disease Control and Prevention shows.

"These little pods are small and colorful, and appealing to small children," explained Dr. Jose Rosa-Olivares, medical director of the Pediatric Care Center at Miami Children's Hospital.

When swallowed, the concentrated cleaning chemicals inside the packets can cause a variety of side effects, from minor stomach or breathing problems to "significant symptoms that can be life-threatening," he said.

Symptoms include belly pain, vomiting, diarrhea and extreme difficulty breathing. Children also can become confused and drowsy, Rosa-Olivares added.

"It is important for parents and caregivers to keep these items out of the reach of children," he said.

If a child does swallow one of these pods, the first thing to do is call the local poison-control center and follow whatever instructions are given, Rosa-Olivares added.

"Many times, the child needs to be immediately transported to an emergency room via EMS," he said. "That could make a difference in what could be a life-threatening situation."

The report was published in the Oct. 19 issue of the Morbidity and Mortality Weekly Report, a CDC publication.

According to the report, more than 180,000 children were poisoned by household cleaning products in 2010 alone. Of these, nearly 9,000 involved laundry detergents.

During the month in 2012 when CDC researchers collected poisoning statistics for their report, more than 1,000 poisonings involved laundry detergents and nearly 500 involved laundry-detergent pods. In addition, detergent pods caused side effects in 76 percent of the children who swallowed them, compared with 27 percent among children who ingested other, less concentrated laundry products, the CDC noted.

"Parents need to ensure they can prevent children from gaining access to household cleaning products -- particularly laundry-detergent pods," the researchers advised. "Clinicians and caregivers are encouraged to report laundry detergent exposures and cases of associated illness to their local poison center by calling 800-222-1222."

The problem is not confined to the United States.

In a recent issue of the journal Archives of Disease in Childhood, British researchers looked at the scope of such poisonings in that country.

In Great Britain, the National Poisoning Information Service received nearly 650 telephone inquiries about laundry detergent poisoning; further research uncovered nearly 4,000 more cases. Those figures make laundry detergent "the most common household product to be accidentally ingested," according to the researchers.

Copyright © 2012 HealthDay. All rights reserved. SOURCES: Jose Rosa-Olivares, M.D., medical director, Pediatric Care Center, Miami Children's Hospital; Oct. 19, 2012, Morbidity and Mortality Weekly Report

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Children with ADHD find medication frees them to choose between right and wrong, study suggests

ScienceDaily (Oct. 16, 2012) — Children living with ADHD tend to feel they benefit from medication to treat the condition and do not think the medication turns them into 'robots', according to a report published October 17. In fact, they report that medication helps them to control their behaviour and make better decisions. The study, which gives a voice to the children themselves, provides valuable insights into their experiences and the stigma they face.

The ADHD VOICES -- Voices on Identity, Childhood, Ethics and Stimulants -- study has worked with 151 families in the UK and the USA to examine ethical and societal issues surrounding attention deficit hyperactivity disorder (ADHD), particularly the use of treatments such as methylphenidate (Ritalin). The project has been led by biomedical ethicist Dr Ilina Singh from King's College London and was funded by the Wellcome Trust.

Dr Singh and colleagues interviewed children and their families about ADHD, behaviour, medication and identity across four contexts: home, school, the doctor's office and peer groups.

The report is intended not only to highlight ethical and social issues surrounding ADHD but also to help families, doctors, teachers and the children themselves to understand from a child's perspective what it is like to live with ADHD.

"ADHD is a very emotive subject, which inspires passionate debate. Everyone seems to have an opinion about the condition, what causes it, and how to deal with children with ADHD, but the voices of these children are rarely listened to," explains Dr Singh. "Who better to tell us what ADHD is like and how medication affects them than the children themselves?"

Dr Singh points out the controversies that surround providing medication to children with ADHD, which some people argue turns the children into 'robots'. She believes that in many cases and with a correct diagnosis, treatment using stimulants is appropriate and beneficial, particularly if it is complemented by other interventions. The evidence from the children she interviewed suggests that they think medication improves their ability to make their own moral choices.

Glenn (age 10), from the USA, says: "If you're driving in a car, and there's two different ways, and you usually always go this way…and then one day you want to go the other way, but…the ADHD acts as a blocker, so you can't.

"[The medicine] opens the blocker so that you can go [the right] way. But you still have the choice of going the wrong way… It's harder [without medication], that's what's the truth. But it's not like [on medication] you're a robot."

Dr Singh also found that children often did not understand their condition or why they were receiving medication, and many children in the study reported that they had little meaningful contact with their doctors. After the initial evaluation, clinic visits tended to focus on side-effect checks, during which children were weighed and measured. Most children were not asked any questions during these visits.

Roger (age 13), from the UK, says: "I've only just started going to the ADHD clinic, but I haven't actually been to it properly. I've seen the doctor and he's talked about [ADHD] and I get weighed. But...they'll just say parts of what it is but then they'll stop, so they will only say some of it and then change the subject."

Dr Singh argues that children need to be better informed and able to discuss their condition. "Given the ethical concerns that arise from ADHD diagnosis and stimulant drug treatment, it is imperative that children are able to openly discuss the value of diagnosis and different treatments with a trusted professional."

The report concludes with a series of recommendations for how parents, doctors and teachers can help children cope with and better understand the condition, and begin to tackle the stigma that currently exists around it.

Professor Peter Hill, a child and adolescent psychiatrist, says: "We hope that the VOICES Study and the ADHD and Me animations will inspire people to think differently about ADHD, drug treatments and children with behavioural difficulties.

"Behaving differently around these children is the main challenge. We hope that the strategies we have outlined will help improve the interactions with these children and help improve their lives."

Clare Matterson, Director of Medical Humanities and Engagement at the Wellcome Trust, comments: "It is refreshing to hear the voices of children included in the debate about ADHD.

"It is a very emotive subject and despite the fact that these children are at the centre of this debate, they are too often ignored. This report sends a clear message to doctors, teachers and parents about the importance of talking to children about their condition -- and more importantly, listening to what they have to say."

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Children with autism can identify misbehavior but have trouble putting it in words, study finds

ScienceDaily (Oct. 17, 2012) — Children with autism have difficulty identifying inappropriate social behavior, and even when successful, they are often unable to justify why the behavior seemed inappropriate. New brain imaging studies show that children with autism may recognize socially inappropriate behavior, but have difficulty using spoken language to explain why the behavior is considered inappropriate, according to research published Oct. 17 in the open access journal PLOS ONE by Elizabeth Carter from Carnegie Mellon University and colleagues.

The authors say the results of their functional MRI studies support previous behavioral studies that reached similar conclusions about language impairment in children with autism. In the current study, the researchers asked children with autism and children with typical development to identify in which of two pictures a boy was being bad (social judgment), or which of two pictures was outdoors (physical judgment). Both groups successfully performed the task, but the children with autism showed activity in fewer brain regions involving social and language networks while performing the task. Even though language was not required for the task, the children with typical development recruited language areas of the brain while making their decisions.

According to the authors, their results support the hypothesis that children with autism may recognize socially inappropriate behavior, but have difficulty using spoken language to explain why the behavior is considered wrong. They suggest that this decreased use of language may also make generalization of the knowledge more difficult.

"These results indicate that it is important to work with these children on translating their knowledge into language," says Carter.

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Carter EJ, Williams DL, Minshew NJ, Lehman JF. Is He Being Bad? Social and Language Brain Networks during Social Judgment in Children with Autism. PLoS ONE, 2012; 7 (10): e47241 DOI: 10.1371/journal.pone.0047241

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