Wednesday, December 21, 2016

Some children at a higher risk for exposure to neurotoxic compounds


A class of flame retardants known as polybrominated diphenyl ethers (PBDEs) have been phased out of production in the U.S. out of concern for their potential neurotoxic effects, particularly in young children. But the compounds persist in older furniture, plastics and textiles, and in dust. Now a new report in the ACS journal Environmental Science & Technology examines the factors that help predict which children could be at a higher risk for exposure to these compounds.

Studies in animals and humans suggest that PBDEs, which are structurally similar to thyroid hormones, could have neurotoxic effects. As a result, various formulations of the flame retardants were phased out in the U.S. as far back as 2004. But the compounds had been added to products such as sofas that people keep for years. And PBDEs can continue to migrate into household dust from these items. Other studies have found that young children, who often put their hands and toys –and any dust that has settled on these items — in their mouths, tend to have the highest concentrations of PBDEs in their blood. Lyndsey Darrow and colleagues wanted to take a closer look to see whether particular groups of children might be affected more than others.

The researchers tested the blood levels of various PBDEs in 80 children between the ages of 1 and 5, all of whom were born after the U.S. phase-out in 2004 of two types of PBDE commercial formulations. Results showed that lower median income within a neighborhood, lower BMI and smoking in the household corresponded to higher PBDE levels. The researchers note that the socioeconomic disparity in PBDE exposure will likely increase over time as the more economically well-off continue to replace their older products with ones that don’t contain these flame retardants. The team speculates that lower BMI could lead to higher PBDE blood concentrations because the compounds accumulate in fat, which leaner kids have less of. However, it is unclear why smoking affects PBDE exposure.


Reducing antibiotic duration does more harm than good for ear infections in young children


In a landmark trial conducted at Children's Hospital of Pittsburgh of UPMC and the University of Pittsburgh School of Medicine, researchers have demonstrated that when treating children between 9 and 23 months of age with antibiotics for ear infections, a shortened course has worse clinical outcomes without reducing the risk of antibiotic resistance or adverse events.

The results of the trial are published today in the New England Journal of Medicine and highlighted by an accompanying commentary.

Acute otitis media is a bacterial infection of the middle ear behind the ear drum which causes it to become painfully inflamed. Three out of four children experience this infection within their first year. Consequently, it is the most common reason why children are prescribed an antibiotic.

"Given significant concerns regarding overuse of antibiotics and increased antibiotic resistance, we conducted this trial to see if reducing the duration of antibiotic treatment would be equally effective along with decreased antibiotic resistance and fewer adverse reactions," said Alejandro Hoberman, M.D., chief, Division of General Academic Pediatrics at Children's, and the Jack L. Paradise Endowed Professor of Pediatric Research at Pitt's School of Medicine.

In the current trial, 520 children with acute otitis media were randomly assigned to either a standard 10-day regimen of the antibiotic amoxicillin-clavulanate or a shortened 5-day treatment followed by five days of placebo. Neither the study participants nor the physicians knew which group the participant was assigned to.

Children were followed starting in October through the rest of the annual respiratory-infection season, and had a final visit during the following September.

They found that the risk of treatment failure in the 5-day group (34 percent) was more than twice as much the risk in the 10-day group (16 percent). The results were significant when considering the trial design which was set up to find out whether the 5-day treatment would be as good as the 10-day regimen, Dr. Hoberman said. Instead, the results clearly showed that not only was their initial assumption proven wrong, but the 10-day treatment was far more effective.

When they tested the presence of antibiotic-resistant bacteria through nasopharyngeal (back of the nose) swabs, there was no decrease in the 5-day group as might have been expected with a shorter duration of antibiotics. Also, reduced-duration antibiotics did not decrease the risk of frequent adverse events like diarrhea or diaper rash.

When testing the risk of a recurrent infection, they found that it was higher when children were exposed to three or more children for 10 or more hours per week, such as in a day care setting, or if the initial infection occurred in both ears as opposed to just one ear.

Importantly, the study also showed for the first time that almost one in two children in whom residual fluid was observed in the middle ear after treatment had a recurring infection, a significantly higher percentage when compared to children without any residual fluid in the middle ear.

The marked superiority of the 10-day regimen over the 5-day regimen led the independent safety monitoring board overseeing the trial to conclude it prematurely as the primary end point was achieved.

"The results of this study clearly show that for treating ear infections in children between 9 and 23 months of age, a 5-day course of antibiotic offers no benefit in terms of adverse events or antibiotic resistance. Though we should be rightly concerned about the emergence of resistance overall for this condition, the benefits of the 10-day regimen greatly outweigh the risks," said Dr. Hoberman.


Physical activity in week after concussion associated with reduced risk of persistent postconcussive


Among children and adolescents who experienced a concussion, physical activity within 7 days of injury compared with no physical activity was associated with reduced risk of persistent postconcussive symptoms at 28 days, according to a study appearing in the December 20 issue of JAMA.

Rest has long been considered the cornerstone of concussion management, and pediatric guidelines universally recommend an initial period of physical rest following a concussion until symptoms have resolved. No clear evidence has determined that avoiding physical activity expedites recovery. Roger Zemek, M.D., of Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada, and colleagues conducted a study that included 3,063 children and adolescents with acute concussion from 9 Pediatric Emergency Research Canada network emergency departments. Physical activity participation and postconcussive symptom severity were rated using standardized questionnaires in the emergency department and at days 7 and 28 postinjury. Persistent postconcussive symptoms (PPCS) were assessed at 28 days postenrollment.

The final study group included 2,413 participants, of whom PPCS at 28 days occurred in 733 (30 percent); 1,677 (70 percent) participated in physical activity within 7 days, primarily with light aerobic exercise. Of the patients who engaged in early physical activity, 31 percent were symptom free and 48 percent had at least 3 persistent or worsening postconcussive symptoms at day 7. Of those reporting engaging in no physical activity at day 7, 80 percent had at least 3 persistent or worsening postconcussive symptoms at day 7. Resumption of physical activity within 7 days postconcussion was associated with a lower risk of PPCS as compared with no physical activity. This finding was consistent across analytic approaches and intensity of exercise.

"Early physical activity could mitigate the undesired effects of physical and mental deconditioning associated with prolonged rest. Regardless of potential benefit, caution in the immediate postinjury period is prudent; participation in activities that might introduce risk for collision (e.g., resumption of contact sports) or falls (e.g., skiing, skating, bicycling) should remain prohibited until clearance by a health professional to reduce the risk for a potentially more serious second concussion during a period of increased vulnerability," the authors write.


   

Young children can choke to death on whole grapes


Very young children can choke to death on whole grapes, warn doctors writing in the Archives of Disease in Childhood.

Foodstuffs account for over half the episodes of fatal choking among the under 5s, with grapes the third most common cause of food related choking after hot dogs and sweets. But public awareness of this potential hazard is not widespread, they say.

They describe three cases of young children, all of whom required emergency treatment after eating whole grapes.

One case involved a 5 year old who started choking while eating whole grapes at an after school club. Prompt and appropriate attempts to dislodge the grape didn't work and the child went into cardiac arrest. The grape was later removed by paramedics, using specialist equipment, but the child died.

In the second case, a 17 month old boy was eating sandwiches and fruit with his family at home, when he choked on a grape. Attempts to try and dislodge it were unsuccessful and the emergency services were called. The grape was eventually removed by a paramedic but the child still died.

The third case involved a 2 year old who was snacking on grapes in the park when he started choking. Again, the grape proved impossible to dislodge, and an ambulance was called. Paramedics were on the scene within a minute and successfully cleared the airway.

The child suffered two seizures before reaching hospital and, on arrival, required emergency treatment to relieve swelling on his brain and to drain a build-up of watery fluid in his lungs. He spent five days in intensive care before making a full recovery.

The airways of young children are small; they don't have a full set of teeth to help them chew properly; their swallow reflex is underdeveloped; and they are easily distracted, all of which puts them at risk of choking, explain the authors.

Grapes tend to be larger than a young child's airway. And unlike small hard objects, such as nuts, the smooth soft surface of a grape enables it to form a tight seal in an airway, not only blocking this completely, but also making it more difficult to remove without specialist equipment, they emphasise.

"There is general awareness of the need to supervise young children when they are eating and to get small solid objects, and some foods such as nuts, promptly out of the mouths of small children; but knowledge of the dangers posed by grapes and other similar foods is not widespread," write the authors.

While there are plenty of warnings on the packaging of small toys about the potential choking hazard they represent, no such warnings are available on foodstuffs, such as grapes and cherry tomatoes, they point out.

As such, they advise that grapes and cherry tomatoes "should be chopped in half and ideally quartered before being given to young children (5 and under)," and emphasise "the importance of adult supervision of small children while they are eating."


Tuesday, December 6, 2016

Kids' restaurant menu items often include excess calories


Most kids' menu items offered by the nation's top 200 restaurant chains exceed the calorie counts recommended by nutrition experts, a new RAND Corporation study has found.

The findings highlight the importance of the upcoming rollout of calorie labeling on most restaurant menus, providing operators with an opportunity to reduce portion sizes so they are more appropriate to meet children's needs, according to researchers.

A panel convened to create guidelines for the calorie content of menus that cater to children's tastes found room for improvement. For example, a la carte items averaged 147 percent more calories than recommended by the expert panel.

The menu item that most often exceeded the calorie guidelines was fried potatoes. The study found that the average calorie count for the popular side dish was 287, nearly triple the recommended amount. McDonald's was the only chain in the study that served fried potatoes in the recommended 100-calorie portions. The findings are published online by the journal Nutrition Today.

"It's important to examine the caloric value of what kids are served because the chances are they will eat all or most of what they are served," said lead author Deborah Cohen, a senior natural scientist at RAND, a nonprofit research organization. "Overeating -- consuming more calories than are needed for normal growth and maintenance -- is a very common problem and a key contributing factor to childhood obesity."

A consensus of 15 child nutrition experts convened for the study recommended a maximum of 300 calories from main dishes for kids' meals. Other recommendations include 100 calories for a serving of fried potatoes, 150 calories for soups, appetizers and snacks, and 150 calories for vegetables and salads that included added sauces. No recommended limit was made for vegetables and fruits that have no added oils or sauces. Kids meals also should include no more than 110 calories of unflavored milk. The entire meal should not exceed 600 calories.

Using the expert guidelines, a burger or a serving of macaroni and cheese should have no more than 300 calories, but the study found that the average calorie content for those items in restaurants was 465 and 442, respectively.

What restaurants offer children is important because they eat out often. According to a study by the federal Centers for Disease Control and Prevention, on any given day 1 of 3 children and 41 percent of teenagers eat at fast-food outlets. The Economic Research Service of the U.S. Department of Agriculture reports that 50 percent of all food dollars are spent on meals away from home.

The study pointed out that appropriate calorie intake is challenging even when restaurants list the calorie counts for each menu item. Many adult consumers ignore or misunderstand the calorie information, and it is "unrealistic to expect that, if served too much, children younger than 12 years will be able to limit what they consume," the study said.

Furthermore, the average customer is ill-equipped to calculate how much of an oversized portion to leave behind or take home unless he or she has "a fluid knowledge of geometry" and brings a measuring cup or other tools, the study noted.

"The public may want to consider how they are at a disadvantage to prevent childhood obesity when so many food outlets serve foods in quantities that put their children at risk," Cohen said. "It is too difficult for children and their parents to limit consumption when they are served too much."

Cohen said the restaurant industry has an opportunity to embrace these calorie guidelines established by child nutrition experts by adjusting kids' menu offerings accordingly in support of promoting children's health and reducing childhood obesity. "Ultimately," she said, "this could mean good business for restaurants."