PEDIATRIC NEWS UPDATES Updates from March 2007

Mar. 22 - Are Peanuts OK For Pregnant Women?
New scientific research suggests that most women who follow general medical precautionary advice and avoid peanuts when pregnant may be doing so unnecessarily.

The standard medical advice is based on a 1998 UK government issued precautionary notice for women with a family history of atopy (asthma, eczema or hay fever) to avoid eating peanuts during pregnancy and breast-feeding as this could increase the chances of peanut sensitisation in children.

But the findings of a study by scientists Dr Tara Dean and Dr Carina Venter at the University of Portsmouth of 858 pregnant women and 660 children suggests the government medical advice is being followed mostly by first-time mothers regardless of family history of atopy. Researchers questioned the women about their diets, and two years later, conducted skin prick tests on the children to detect peanut sensitisation.

The findings revealed that 65 percent of women (whether atopic or not) followed the advice and stopped eating peanuts. The skin prick tests revealed 13 out of 660 children were sensitised to peanuts (two percent of the sample). Of this group of 13 children, 11 had a family history of atopy, while 10 out of 13 mothers said they avoided peanuts during pregnancy.

"Mothers of 77 percent of children sensitized to peanuts had avoided peanuts during pregnancy. In this cohort study, maternal consumption of peanuts during pregnancy was not associated with peanut sensitization in the infant," the scientists wrote in a paper published this week in the Journal of Human Nutrition and Dietetics.

The scientists called for a review of the 1998 Department of Health advice issued by the Committee on Toxicity in Chemicals in Food, Consumer Products and the Environment (COT).

"It is likely that the COT advice is misunderstood by mothers of those who communicate that advice have not fully explained who it is targeted at," the scientists said.

"Not surprisingly, most mothers who heard the advice had heard of it through their midwives. At the first booking appointment (during the first trimester), midwives highlight certain dietary precautions to safeguard the baby's wellbeing."

"It is likely that avoidance of peanut is often communicated as blanket advice or interpreted as blanket advice regardless of family history of atopy. It has previously been shown that this 'blanket approach' causes confusion amongst mothers (Turke et al., 2005)."

"This study reveals the requirement for clear, consistent factual advice and information about the real risks associated with peanut consumption during pregnancy/lactation and peanut allergy in the developing child, and specifically to whom these risks apply."

The research was carried out at The David Hide Asthma and Allergy Research Centre on the Isle of Wight (UK).

Mar. 07 - Study Measures Harm of Stress on Children's Health
Reuters News service

Children in families facing chronic stress such as conflict between parents or violence in the home become sick more often than children under less stress, according to a study published on Monday.

Researchers led by Dr. Mary Caserta at the University of Rochester Medical Center in Rochester, New York, tracked the incidence of fevers in 169 children ages 5-10 from diverse racial and socioeconomic backgrounds.

The researchers said the reason why children from stress-filled families experienced fevers more often was unclear -- and another of their findings was a bit surprising.

While one might have expected that the immune systems of the children under chronic stress might be suppressed as they are in adults, the opposite appeared to be the case. Blood samples showed that these children had stronger functioning of certain key cells in the immune system.

The researchers were seeking a greater understanding of the effect of chronic stress on children's health.

"I think people on the street believe this unflinchingly -- stress makes you sick," Caserta said in an interview, but she wanted the study to put this to the test.

Parents of the children in the study tracked chronically stressful events in the family and their own symptoms over the course of the study, kept a diary on the health of their kids, and were given digital thermometers.

Conflict in the household, parental anxiety and depression, parental poverty and unemployment, and violence in the home or neighborhood were among these stressful conditions.

Fever was chosen as a benchmark of illness because it is easily measured and not judged subjectively. "As an infectious disease physician, I really like measurements of temperature because they're very objective," Caserta said.

The study, published in the journal Archives of Pediatric and Adolescent Medicine, found that the children under stress experienced more fevers than other children.

The researchers now hope to figure out specifically which types of stress increase the frequency of illness, and what biological processes control susceptibility to infections, which cause fevers.

"We really have to get at the mechanisms and what is going on and accounting for these increased illnesses," Caserta said.

Previous studies primarily involving older adults showed that chronic stress drives down the function of immune system cells called natural killer, or NK, cells. But this study yielded a counter-intuitive result in children.

"We found that the highest-stress kids had the highest amount of NK cell function," Caserta said.

Caserta said more research is needed to figure out what is causing this, but added that it could be because the children's immune systems are still developing.

Mar. 07 - Study: Childhood Obesity Triggers Early Puberty
Reuters News Service

Childhood obesity in the United States appears to be causing girls to reach puberty at an earlier age, for reasons that are not clear.

The report from the University of Michigan's Mott Children's Hospital said a multiyear study following a group of 354 girls found that those who were fatter at age 3 and who gained weight during the next three years reached puberty, as defined by breast development, by age 9.

"Our finding that increased body fatness is associated with the earlier onset of puberty provides additional evidence that growing rates of obesity among children in this country may be contributing to the trend of early maturation in girls," said Dr. Joyce Lee, the lead author.

"Previous studies had found that girls who have earlier puberty tend to have higher body mass index, but it was unclear whether puberty led to the weight gain or weight gain led to the earlier onset of puberty," she added.

"Our study offers evidence that it is the latter," Lee said.

Earlier studies have found that U.S. girls are reaching puberty earlier than was the case 30 years ago, a time span during which rates of childhood obesity also increased, the study said.

In the study girls were classified as at risk for being overweight if their body mass index (a measurement of weight related to age and height) was between the 85th and 95th percentiles, and defined as overweight if the measurement was greater than the 95th percentile.

The researchers said that 168 of the girls were classified as being "in puberty" by the age of 9 and nearly two dozen reported having their first menstrual period by two years later.

Higher body mass index scores at all ages had a "strong association with earlier onset of puberty, the authors said.

The study was published in Pediatrics, the journal of the American Academy of Pediatrics.

"Earlier onset of puberty in girls has been associated with a number of adverse outcomes, including psychiatric disorders and deficits in psychosocial functioning, earlier initiation of alcohol use, sexual intercourse and teenage pregnancy and increased rates of adult obesity and reproductive cancers," the study said.

Mar. 07 - Study: Ibuprofen Best Painkiller For Kids
AP News service

Deciding which medicine to give a child in pain just got easier: The first head-to-head study of three common painkillers found that ibuprofen works best, at least for kids with broken bones, bruises and sprains.

Available generically and under the brand names Advil and Motrin, ibuprofen beat generic acetaminophen and codeine in an emergency room study of 300 children treated at a Canadian hospital.

The youngsters, aged 6 to 17, were randomly assigned to receive standard doses of one of the three medicines. They then periodically rated their pain. Half an hour later, ratings were similar in the three groups. But starting an hour after taking the medicine, children who got ibuprofen reported substantially greater pain relief than the other two groups.

Children rated their pain on a 100-point scale before and after taking the medicine. At 60 minutes afterward, scores for children who got ibuprofen had dropped 24 points, compared with 12 points for the acetaminophen group and 11 points for the codeine group. The differences remained at 120 minutes.

Also at 60 minutes, about half the ibuprofen children reported what doctors considered "adequate" pain relief, or scores below 30, compared with 40 percent of the codeine children and 36 percent of the acetaminophen group.

There were no major side effects although one child was accidentally given an overdose of codeine and was removed from the study. That child was treated and monitored but showed no ill effects, the researchers said.

The study was done at Children's Hospital of Eastern Ontario in Ottawa , and a research institute at the hospital funded the study. Results appear in the March edition of Pediatrics.

The study sheds light on two common problems in pediatrics — children with broken bones, sprains and strains, and "what should we give them" for pain, said Dr. Catherine Skae, a pain specialist at Children's Hospital at Montefiore Medical Center in New York. "It's good that somebody looked at it systematically."

For parents, choosing a painkiller for kids can be confusing, partly because acetaminophen, sold as Tylenol, and ibuprofen both work against fevers. Codeine does too, but it's a mild narcotic available only by prescription.

The study should ease that dilemma, said lead author Dr. Eric Clark of the University of Ottawa .

Studies comparing ibuprofen with acetaminophen for pain relief have had conflicting results, but Clark said his is the first to compare all three drugs.

Doctors in hospitals often prefer using ibuprofen for children with broken bones because they seem to do better on it, and the study validates that practice, said Dr. Steven Krug, head of emergency medicine at Chicago's Children's Memorial Hospital.

Ibuprofen may work better for pain from trauma because it targets inflammation while acetaminophen and codeine do not, Krug said.

McNeil Consumer Healthcare, which makes both Children's Motrin and Children's Tylenol, issued a statement saying the study "confirms that both ibuprofen and acetaminophen are effective pain relievers in treating children's pain from body injuries that result in emergency room visits."

The company also acknowledged that the two drugs work differently.