Tag Archives: Journal of Pediatrics

Understanding pediatric sudden cardiac arrest (SCA)

Would you recognize the warning signs of pediatric sudden cardiac arrest (SCA)? If not treated in minutes, SCA can result in death.

In a new policy statement to be published online on Monday, March 26, the American Academy of Pediatrics (AAP) provides guidance for pediatricians on underlying cardiac conditions that may predispose children to SCA.

Although the risk for SCA increases when children with underlying cardiac disorders participate in athletics, SCA can occur at very young ages and also when a child is at rest.

Research supports the need for a SCA registry, says the AAP. A registry would help experts gain a better understanding of the nuances of the condition.

Plus, many cardiac disorders are known to be genetic, so the evaluation of family members, even if asymptomatic, could be a critical step in the overall diagnosis of disorders predisposing to pediatric and young adult SCA.

We asked Arizona Pediatric Cardiology Consultants (APCC), members of the Arizona Chapter of the American Academy of Pediatrics, to weigh in on what parents need to know about SCA.

How common is SCA?  

According to the Centers for Disease Control, each year 2,000 individuals less than 25 years of age will die suddenly with the majority of these having a cardiac etiology.

What causes SCA?

Pediatric sudden cardiac arrest and sudden cardiac death can occur with various types of cardiac causes, including conditions in the heart muscle (such as hypertrophic cardiomyopathy), unusual positioning of a coronary artery, or an electrical disturbance within the heart. (Long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia).

More on genetic cardiac conditions from the Sudden Arrhythmia Death Syndrome Foundation (SADS)

How are family members evaluated, and what symptoms may be indicators that a child is pre-disposed to this? 

Signs that may suggest an increased risk for SCD include fainting or seizure with exercise, excitement, or startle, significant dizziness with exertion, unusual and consistent shortness of breath or chest pain with exercise.

If a family member has died suddenly or unexpectedly at a young age, has unexplained seizure disorder, died at a young age from a heart problem, or has a history of fainting, then screening is appropriate.

How do doctors determine if a child is at risk? What tests are performed?

Evaluation by a pediatric cardiologist will include a thorough individual and family history, ECG, physical exam and perhaps an echocardiogram, an exercise stress test, and genetic testing if necessary.

Would automatic external defibrillators (AED) on playing fields and in schools help?

A great majority of these deaths relate to a life-threatening arrhythmia, ventricular fibrillation. CPR and use of an AED may be life saving.  AEDs are often found in airports, casinos, and government buildings.

However, there is no law in Arizona currently requiring AED within schools, recreational sports fields, or other private facilities.

Are efforts being made to increase the availability of AEDs?

The decision about whether to have an AED on location is left up to the individual organization.  APCC’s electrophysiologists are making an effort to educate schools, sports organizations, and families regarding the importance preparation to prevent SCD.

The role of an ECG in all sports physicals remains a debated topic within the United States.  It is, however, very important to ask specific questions (use the attached screening tool) for risk factors and then refer to a pediatric cardiologist for further assessment.

What should parents or caregivers do if they believe a child might be at risk?

Once an individual is identified as having any of the conditions listed above, it is very important for first degree relatives to also be evaluated by a pediatric cardiologist even if they are not experiencing symptoms.

Sudden Cardiac Death is devastating to not only the families of those affected but to the communities in which they live.  Educating  families, schools, sports leagues, and primary care providers about quick and effective screening for children at risk for SCD is a first step in prevention.

Increased community awareness and the availability of AEDs in schools and sporting venues will help avert a tragedy.

Karen S. Eynon, RN, MSN, CPNP, MATS,  compiled these answers with support from Mitchell Cohen, MD, Andrew Papez, MD, and Jennifer Shaffer, RN, MS, CPNP, all of Arizona Pediatric Cardiology Consultants along with information from SADS.org.  

Check with your child’s physician if you are concerned about risks for SCA.

More from Parent Heart Watch, a network of parents and partners dedicated to reducing the effects of SCA.

 

An increase in synthetic marijuana use among teens

Synthetic versions of marijuana are sending some teens to the hospital, says a case report to be released in the April issue of Pediatrics.

The drugs, created in uncontrolled settings and sold in gas stations and convenience stores, consist of herbs sprayed with chemicals that mimic the

Courtesy DrugFreeAZ.org

psychoactive properties of THC, Continue reading

New findings on what may lead kids to binge drinking

A recent study published by the American Academy of Pediatrics found that that the more exposure teens had to alcohol use in movies, the more likely they were to binge drink.

The age, affluence and rebelliousness of the teens did not seem to matter. And this pattern was observed across cultures in countries with different norms regarding teen and adult alcohol use and drinking culture.

What can parents do to make sure kids don’t pick up the cues from the many movies out these days that show alcohol use? And what are some ways that parents can prevent a child from binge drinking?

Dr. Dale Guthrie, a pediatrician in practice at Gilbert Pediatrics, says communication is the key.

Guthrie, who serves as vice president of the Arizona Chapter of the AAP, encourages parents to stay involved — and to make sure to meet and know their children’s friends, from the early days of pre-school right on through high school.

More tips from Dr. Guthrie on how to help prevent your child from using alcohol and other drugs:

  • Know where your teen is at all times.  Teens may act as if they don’t like it but teens are actually more secure knowing their parents care enough to know where they are and what they’re doing.
  • Consciously and genuinely praise your teen for something good he does every day.
  •  Make sure she knows she can talk to you about anything, at any time, if it is important to her and that she won’t be interrupted judgmentally with a lecture.
  •  Remember you are his parent, (not his best friend, afraid to step on his toes) and offer advice when requested and at opportune teaching moments in short phrases, not long lectures which are tuned out anyway.
  •  Better yet, ask inspired questions of your teen—the kind which help her arrive at the correct solution.
  •  Attend movies with your teen and then ask open-ended questions about what he thought about it.
  •  At a nonthreatening time, (not right as your teen is headed out to a movie), sit down as a family and discuss what are your family goals and standards.  As part of that, set family standards for what types of movies you will view and which are beneath your family standards.
  •  When your teen returns from being out with friends, it is helpful to have a “check-in” with parents.  If the tradition has been set that he will give parents a hug (or even a kiss) no matter what time he returns, parents will know more about what he’s been doing  just by being close to him, listening and observation.

Parents of younger children might not be thinking about the teenage years, but is there anything they can do to lower the risk that their child will abuse alcohol down the road?

Will your six-year-old become a teen drinker?

One very simple way is for parents to make sure they truly listen to their child right from the start.

Guthrie says that children need to feel that what they say is of prime importance to their parents. “Then when she has something really serious to discuss, he adds, “she will feel comfortable coming to you.”

Modeling healthy behaviors themselves, and engaging kids in conversation at opportune moments (short snippets in lieu of lengthy lectures) are other ways parents can make a difference, says Guthrie.

RAK Archives: Talking to teens about alcohol poisoning

More on talking to kids about drugs and alcohol, and upcoming Parent Workshops from the Partnership for a Drug-Free America, Arizona Affiliate

Getting breastfeeding off to a good start

Where you choose to deliver your baby may have a tremendous impact on reaching breastfeeding goals, says pediatrician and lactation consultant Laurie Jones, MD, IBCLC.

Laurie Jones, MD, and Tanya Belcheff, CNM, examine day-old Judel Alia

That’s because a key predictor of long-term success for breastfeeding rests on what happens between a mother and her newborn in those precious hours after birth.

Doctors, nurses, hospital policies, and family member interaction- even well-meaning visitors—can “make or break” the early breastfeeding relationship. “Babies and mothers are programmed with instincts to breastfeed, says Jones, who practices at St. Joseph’s Hospital and Medical Center, “but modern hospitals and health care providers mostly get in the way or interrupt those instincts.”

Jones, a member of the Arizona Chapter of the American Academy of Pediatricians says the Arizona Baby Steps program, launched by the Arizona Department of Health Services (AZDHS), has worked wonders at hospitals across the state to train nurses, doctors, and administrators in the best ways to support breastfeeding mothers after delivery.

More on how Arizona is helping moms to meet breastfeeding goals

The program promotes the implementation of five evidence-based maternity care practices that help a new mom to meet her breastfeeding goals.

Funded in part by the Centers for Disease Control and Prevention (CDC), the voluntary program was offered to hospitals in Arizona by the AZDHS, and implemented beginning in early summer, 2010.

The most important thing a mother can do to get breastfeeding off to a good start, says Jones, is to have unrestricted and uninterrupted time “skin-to-skin” in the first days following birth.

That first hour immediately after birth, says certified nurse-midwife Tanya Belcheff, MSN, CNM, should be considered the “golden hour.”  Belcheff, who also practices at St. Joseph’s, says it’s a time to cuddle, to bond- and can even predict the duration of the breastfeeding relationship.

“Studies show that the number of minutes you can have your baby skin-to-skin immediately after delivery, says Belcheff, “directly correlates with the number of months that you are successful at breastfeeding.”

It’s a new-old concept, she adds,  which helps regulate a newborn’s temperature, glucose levels, and breathing rate.

Also known as “metabolic stabilization,” Jones says that a baby will warm faster on a mother’s chest –or a father’s chest, or a partner’s chest, for that matter — rather than the traditional warmer used in hospitals. No matter what the feeding method is — breast or formula – this early contact is best for a new baby.

If moms come in asking for skin-to-skin contact during labor, and the nurses understand the importance, they are more likely to get it, says Belcheff, so it is important for labor/delivery professionals to educate their patients during pre-natal care.

Dr. Jones with Dr. Plimpton, who delivered Judel

Dr. Steven Plimpton, MD, an OB-GYN in private practice in Phoenix, says that that skin-to-skin contact is often offered as routine by labor and delivery nurses who understand and appreciate the benefits. “The mom will do it right away, assuming that it is the best thing for the baby.” This early contact helps bring in the breast milk, too.

A first bottle during the very early hours, says Plimpton, can interfere with the process. “The baby sucks it down like it’s the best thing in the word, and then the mom thinks she’s inadequate because the baby doesn’t suck on her like that, or cries when she tries to put her to the breast. The more you promote it right at the beginning, I think the more successful it’s likely to be.”

AAP new updated policy clearly says that all procedures should be delayed until after the first feeding, says Jones. But expanding that policy beyond the pediatric literature takes time.

Preparing for breastfeeding: what to ask your pediatrician

Getting everyone on board – obstetricians, midwives, family practice doctors, nurses –who helps participate in the birthing experience — is the best way to get baby off to a good start.

That’s why policies like Arizona Baby Steps are needed, so that nothing is left to chance. As long as the baby has a healthy Apgar score, which can be taken while the baby is on mom’s chest, says Jones, other routine procedures, like weighing and giving medicines – can wait.

Expectant moms should make a birth plan, says Belcheff, and discuss their wishes with their care provider. Jones says that a mother can reach her breastfeeding goals with a strong belief that she can do it and by making choices that support her goal. “Don’t overthink things in the first few days — human mothers have been doing this with no other option for 267 million years. And you can, too!”

 Jones offers the following tips on what expectant moms should know in order to get breastfeeding off to a good start:

  • Choose a hospital that has inpatient lactation consultants (designated as IBCLC) seven days a week and trains nurses and other providers in basic breastfeeding support.
  • There are still many hospitals that keep babies in a separate unit to get routine phototherapy or routine antibiotics which is very disruptive and always detrimental to the early establishment of a mother’s milk supply.
  •  Discuss a birth plan with your birth provider that includes immediate skin-to-skin after delivery and keeping mother and baby together at all times during the hospital stay with minimal interruptions.
  •  Let the nurses and doctors know that you do not want any formula, bottles, or pacifiers given to your baby.
  • Ask friends and family to visit during a limited window of time so that you have as much uninterrupted time with your baby as possible to be free to learn your baby’s hunger cues and needs.
  • Avoid any hormonal contraception until breastfeeding is well-established at the earliest around 6 weeks post-partum.

Arizona Baby Steps to Breastfeeding participating hospitals and medical centers

Greater Phoenix Area:

Banner Baywood Medical Center

Banner Del E. Webb Medical Center

Banner Desert Medical Center

Banner Estrella Medical Center

Banner Gateway Medical Center

Banner Good Samaritan Medical Center

Banner Thunderbird Medical Center

Chandler Regional Medical Center

Maricopa Integrated Health System

Mercy Gilbert Medical Center

Mountain Vista Medical Center

Phoenix Indian Medical Center

St. Joseph’s Hospital and Medical Center

Other participating Baby Steps hospitals in Arizona:

Carondelet Holy Cross Hospital, Nogales

Carondelet St. Joseph’s Hospital, Tucson

Casa Grande Regional Hospital

Flagstaff Medical Center

Kingman Regional Medical Center

Northwest Medical Center, Tucson

Sierra Vista Regional Health Center

Summit Healthcare Regional, Show Low

Tucson Medical Center

The University of Arizona Medical Center, Tucson

Yavapai Regional Medical Center

Yuma Regional Medical Center

Source: Anne Whitmire, Breastfeeding Program Manager

Arizona Department of Health Services

Snoring linked to behavior problems in children

Children who snore or who have other sleep-related breathing problems are more likely to have behavioral problems years later, says a new study to be published in the April 2012 issue of Pediatrics.

Researchers asked a group of parents about their children’s snoring, mouth breathing, observed apnea and behavior, starting at age 6 months and then periodically until age 7 years.

By age 4, the children with sleep-disordered breathing were 20 percent to 60 percent more likely to have behavioral difficulties. By age 7, the likelihood jumped to 40 to 100 percent.

The worst symptoms were associated with the worst behavioral outcomes, meaning that the kids who faced more serious sleep-related breathing problems also tended to be more likely to struggle with behavior issues.

Study authors conclude that sleep-disordered breathing early in life can have a strong effect on behavior later in childhood.

Kids who have these difficulties may miss out on critical periods of brain development that researchers believe take place during deep sleep.

The study findings suggest that these symptoms may require attention as early as the first year of life.

Dr. Mark Brown, pediatric pulmonologist at the University of Arizona College of Medicine, and a member of the Arizona Chapter of the AAP, weighs in on kids and snoring:

 When should a parent be concerned about snoring?

  •  When a child can be heard snoring outside of their room.
  • When a child has disrupted sleep with short “pauses, snorts, or gasps” in their sleep.
  • If the child is having behavioral problems, a short attention span and problems at school.
  • If the child, especially an older child, frequently falls asleep during the day (i.e. in the car, during a TV show or movie, while reading).
  • In severe cases, there can be difficulty with weight gain or obesity, or high blood pressure.

Is a little light snoring okay?

Light snoring without any of the above associated signs/symptoms may be “normal.” If there is any concern, the parent should consult with their child’s primary care physician.

How do you know when snoring needs medical attention?

 If any of the above signs/symptoms are seen or if the parent is unsure about the significance of their child’s snoring they should consult with their child’s primary care physician.

RAK Archives: More on the consequences of too little sleep, and what families can do about it.

RAK Resources on respiratory issues: Take a Deep Breath by Dr. Nina Shapiro

Find out what technicians at the Sleep Center at Cardon Children’s Medical Center learn by watching children sleep:


Play ball — but protect young athletes from overuse injuries

The rates of injury for baseball and softball are relatively low compared to other sports, but the degree of injury severity is relatively high.

To protect young athletes, the American Academy of Pediatrics recommends that qualified adults instruct kids on proper throwing mechanics, training and conditioning.

Adults need to encourage athletes to stop playing and seek treatment when signs of overuse injuries arise.

Dr. Mike Perlstein, AzAAP board of directors member, says that over the past 20 years, the range of sports available through schools and through city recreational departments for children of all ages to participate in has grown.

But as the opportunities for playing sports has increased, so has the perceived competitive level.  Often, says Perlstein, the difference between a select or competitive team and the corresponding recreational team has been blurred.

And as the competitive nature of sports has heated up, the pressure applied by coaches and/or parents to succeed can be stifling.

In reality, an extremely small percentage of student athletes continue participating in competitive sports through high school, college, and beyond, Perlstein says.

So, parents should take a step back and think about what else young athletes can learn from participating in sports. “ I feel the lessons involved in competition are important for kids to learn,” he adds, “but should be secondary to the more important in lessons of having fun and exercising.

Perlstein, who practices at  Palo Verde Pediatrics in Gilbert, recommends that patients and their families avoid hyper specializing in any given sport until at least age 12.  “Experiencing a broad range of sporting activities, and developing different skill sets focusing on different muscle groups, is very important.”

Perlstein says that helps kids to develop in to well-rounded athletes and avoid overuse injuries. Which is important at any age — but especially in those younger athletes who have not yet reached puberty.

Overuse injuries, by definition, are almost all preventable, according to Perlstein. And the list of significant injuries documented in today’s young athletes continues to grow.

That is a source of frustration, he adds, because many of these injuries could be minimized or prevented with appropriate training strategies.

“Physical stresses on the pre-pubertal body need to be managed differently than in an athlete with a fully mature body,” he says. “For example, I do not recommend weight training with free weights until the student athlete is well into pubertal development.”

Repetitive activities, especially in relation to the upper arm, such as involved in tennis, swimming, and baseball/softball  need to be managed closely.  “Student athletes, their coaches, and their families all need to listen to the student athlete and for potential signs or symptoms of possible evolving overuse injuries.”

Have a young athlete with a single sport interest? Here are Perlstein’s recommendations:

  • Make sure the child continues to enjoy the activity, and is not simply feeling the pressure to continue.
  •  Spend intermittent time away from the sport to allow their body time to heal and to “re-charge their battery”.
  • Follow up with a sports medicine trained staff to watch for evidence of physical stress or imbalance in their flexibility or strength to avoid overuse injuries.

Not everyone may know exactly when an athlete begins to show signs of overuse, says Stephen Rice, MD, FAAP, a co-author of the AAP policy statement. “But it is important to know to never pitch when one’s arm is tired or sore. Athletes must respect the limits imposed on throwing, including pitch counts and rest periods.”

Additional AAP recommendations for young athletes include:

  • All players should wear appropriate protective gear to avoid injury. Polycarbonate eye protection or metal cages on helmets should be worn when batting.
  • Coaches should be prepared to call 911 and have rapid access to an automated external defibrillator if a player experiences cardiac arrest or related medical condition.
  • All coaches and officials should be aware of extreme weather conditions (heat, lightning) and postpone or cancel games if conditions worsen and players are at risk.
  • Not all children will develop at the same rate, so repeated instruction and practice are essential for young baseball and softball players to acquire basic skills when learning the fundamentals of the game.

RAK Archives:

Strength training for teens

Twitter chat with Cardon Children’s Medical Center sports medicine specialist Udall Hunt, MD

What you can learn from training the best: A conversation with veteran strength and conditioning coach Tim McClellan

Helping children with gender identity disorder (GID)

Children who are persistently uncomfortable with their gender who display strong and consistent cross-gender behaviors may be experiencing gender identity disorder, or GID.

A new study to be published in the March 2012 issue of Pediatrics found that children who do not receive medical treatment or counseling for GID can be at high-risk for certain behavioral and emotional problems.

Researchers found that of the 97 patients younger than 21 years who met the criteria for GID, 44 percent had a prior history of psychiatric symptoms, 37 percent were taking psychotropic medications, and 21.6 percent had a history of self-mutilation and suicide attempts.

Study authors advocate for early evaluation of children exhibiting GID, but treatment with medications should not be started until they reach puberty.

Why would a child be uncomfortable with his or her gender?

Pediatric surgeon Kathy Graziano, M.D., of Pediatric Surgeons of Phoenix, treats patients who are born with reproductive anomalies.  She says that one reason is that some girls are exposed to excess hormones at birth, and are born with male-looking parts. And some girls are born without some parts, like a vagina or a uterus.

Those are relatively rare conditions, says Graziano, who is a member of the Arizona Chapter of the American Academy of Pediatricians (AzAAP). “But there is a condition, also rare, in which a child is born with all the “right” reproductive organs but identifies with the other gender.”

This is known as gender identity disorder, gender dysphoria or gender incongruence. “This is a problem for the child and the parents from early on.”

Graziano recalls meeting — and being inspired by — a patient who always knew that she was a boy.

“She dressed as a boy, insisting on wearing a boy’s bathing suit for example, as early as anyone could remember,” says Graziano.  “She only once wore a dress…at her sister’s wedding.”

Then, in middle school, she became deeply depressed — and even suicidal.

The patient and her family attended counseling. That’s where she was able to admit that she wanted to be a boy, says Graziano. “The family took an accommodative approach.  They allowed her to change her name to a male name and act in society as a boy.  They sought surgical solutions for her to start transforming her anatomy.”

This was slow-going, says Graziano, since in this country there have been few surgical interventions for children under the age of 18.

Graziano says that the patient ultimately started a support group for other adolescents with gender identity issues. She entered college as a male, although not anatomically.  “Her story is a success in that her family’s intervention saved her life.”

There is also a therapeutic approach to treat, and try to reverse, gender identity disorder when it is recognized early, adds Graziano, but research on the success of these two approaches is lacking.

Pediatricians dealing with these issues should screen for depression and intervene as soon as possible. Parents who suspect that a child is dealing with GID should talk to their child’s physician.

“The most important thing,” says Graziano, “is to focus on the mental health of the child and the family.”

Pediatricians and parents should consult with experienced mental health professionals for children and adolescents experiencing gender-related issues. When patients are sufficiently physically mature to receive medical treatment, they should be referred to a medical specialist or program that treats patients with GID.

Resources for parents

Central Arizona Gender Alliance

TransYouth Family Allies

Rotovirus vaccine, breastfeeding, science…and why I ask the experts

A few weeks ago, a lucky friend with a beautiful new baby shared a link on Facebook from the web site “Natural News” that grabbed my attention, and as a nursing mother, hers, too.

The Natural News is part of a company called The NaturalNews Network, and, according to their site, “is owned and operated by Truth Publishing International, Ltd., a Taiwan corporation.”

The headline read:

 “CDC researchers say mothers should stop breastfeeding to boost the ‘efficacy’ of vaccines” was the headline.

What? Stop breastfeeding?

I’d just written a story for our February issue on Baby Steps to Breastfeeding, a state initiative to help support mothers with their breastfeeding goals.

I had been all over the Centers for Disease Control (CDC) site. I researched the Surgeon General’s Call to Action, an initiative that “seeks to make it possible for every mother who wishes to breastfeed to be able to do so by shifting how we as a nation think and talk about breastfeeding.”

I finished that story understanding that increasing breastfeeding rates and duration had truly become a public health issue, and that we’d come a long way since the days when formula feeding was the default choice.

So I was stunned to think that CDC researchers would say “mothers should stop breastfeeding to boost the ‘efficacy’ of vaccines.”

I wanted to dig a little deeper.

The study the Natural News wrote about was actually the link to an abstract. For anyone who isn’t familiar with the way scientific research is presented, an abstract is a short version of a study with just the facts spelling out what was studied.

Abstracts are written in scientific lingo, and not so easy for the lay person to understand. It’s a science thing.

I wasn’t sure exactly what the study meant even after reading the abstract; I’m a lay person type.

The purpose of the study, according to the authors, was to find out why rotovirus vaccines have been less effective on children in poor developing countries compared with middle income and industrialized countries. 

But what did that have to do with stopping breastfeeding?

As a health writer for Raising Arizona Kids, and as a journalist, when I don’t understand what study findings actually mean, I start asking questions. I find experts who can help translate scientific speak – so that I can pass that information on to our readers.

So I sent the link to the Natural News column along with a link to the abstract to the Arizona Chapter of the American Academy of Pediatrics (AZAAP) to find out what the study findings really meant.

And, I wanted to know if the findings had any bearing on women in the U.S.

Were researchers for the CDC trying to discourage women from breastfeeding? Were they trying to push vaccines in lieu of breastfeeding? Was there some kind of conspiracy going on that I didn’t know about? What’s the rotovirus anyway? I’d never heard of anyone catching that in this country.

Here’s the answer to my questions from AZAAP members Karen Lewis, M.D., F.A.A.P., who is the medical director of the Arizona Immunization Program Office at the Arizona Department of Health Services, and Sudha Chandrasekhar, M.D., M.P.H., F.A.A.P., the breastfeeding coordinator of Gateway Pediatrics in Chandler.

What is rotovirus?

Rotavirus is the most common cause of severe diarrhea in children under 5 years of age.  Rotavirus disease is responsible for over 500,000 deaths a year in the world, with more than 85% of deaths occurring in low income countries.

The U.S. has much lower death rates from rotavirus than low income countries, but rotavirus infections in the US still cause significant suffering and economic burden due to dehydration, doctor visits, and hospitalizations.

When is this vaccine given to babies?

Rotavirus vaccine is recommended as a routine vaccine for infants, either as 2 or 3 doses depending on the manufacturer.  The rotavirus vaccine is a “live” vaccine.  It stimulates the immune system by growing in the intestines.

Therefore, substances that slow the growth of the rotavirus vaccine virus could possibly decrease how well the vaccine stimulates the immune system.

Wouldn’t breast milk have enough immune support to protect a baby from the virus? For any baby, anywhere in the world?

Even when mothers breastfeed, their infants can still get sick and die from rotavirus.  Since rotavirus kills so many infants in low income countries, it is important to find ways to make sure that rotavirus vaccines can work as effectively as possible.

However, clinical studies have shown that children in low income countries do not get as good of protection from rotavirus vaccine as children in high income countries.  Researchers have suggested that this could be due to breast milk providing such good natural immunity that it slows down the growth of the rotavirus vaccine virus, making the vaccines less effective.

But the study seems to imply that researchers want mothers to discontinue breastfeeding. That’s the what the Natural News opinion writer is proposing.

Breastfeeding is wonderful nutrition.  In addition, it strengthens infants’ immunity by providing them with white blood cells and antibodies from their mothers.

Unfortunately formula is often substituted for breastfeeding.  When this happens in lower income countries, the combination of mixing formula with contaminated water and poor community sanitation greatly increases the risk of illness and death.  Therefore, it is crucial to encourage breastfeeding in low income countries.

So researchers set out to prove that breastfeeding might actually prevent the vaccine from working? Does this apply to women and babies in the U.S.?

Dr. Sung-Sil Moon and associates studied this theory, and published their findings in the October 2010 issue of the Pediatric Infectious Disease Journal in an article entitled “Inhibitory Effect of Breast Milk on Infectivity of Live Oral Rotavirus Vaccines.” 

They found that breast milk in Indian women had higher levels of antibodies against rotavirus than American women.  When the breast milk was tested in the laboratory, breast milk from Indian women slowed down the growth of rotavirus better than breast milk from women in the U.S.

This research suggests that when a mother’s breast milk has high levels of rotavirus antibody, breastfeeding may slow down the vaccine virus enough so that the vaccine doesn’t work as well as it could.

So the breast milk antibody level differs in women around the world?

In addition, the article pointed out that since antibody levels against rotavirus in the breast milk of U.S women are much lower, it would not be expected that mothers who breastfeed in the U.S. would have high enough antibody levels to decrease the effectiveness of the rotavirus vaccine.

Based on these new findings, the authors discussed whether the rotavirus vaccine virus would be more effective in low income countries if mothers were to delay breastfeeding for a short time before and after rotavirus vaccine was given to their infants.

Delay? What does it mean when they use the word “delay” in the abstract? That’s confusing.

The authors did not specify the length of time that might be needed.  In order to answer the question about delaying breastfeeding, they would have to decide on what they thought was a reasonable time period for a delay, write a proposal, and conduct a clinical trial.  The authors did not go into any of those details in their current article.

Breastfeeding is essential for children’s nutrition and health and hydration—especially in a low income country where giving formula might increase a child’s risk of exposure to bacteria-contaminated water.  Therefore, the logical approach would be that any “delay” would have to be short-lived.

How short is short-lived? If a mother stops breastfeeding for a certain period of time, her milk will decrease and she might not have enough milk to continue.

An educated guess would be that a delay would be more than just a few minutes, because it takes close to an hour for over half of the stomach contents to pass through the stomach.

So, for example, if a child had not received breast milk for 2 hours, there would be a lot less breast milk in the stomach to have an inhibitory effect on the vaccine.  Then, by waiting an hour after vaccination to feed, there would be more time for the vaccine to get into the intestines without being slowed down by a stomach full of breast milk.

So how would researchers figure out what to recommend in terms of “delay” time?

A scientific clinical study might be done with several different time periods of delay (with clean water or formula supplementation in the interim) in order to see if the length of the delays had any different effect on the level of immunity from the vaccine.  Other clinical studies might be done to see if a higher dose of vaccine could overcome the inhibitory effects of breast milk in low income countries.  However, clinical studies to answer these questions may not be done in the near future because of not having any funding to do so.

I can’t emphasize enough that the discussion of “delay” in the article was part of scientific brainstorming, and not part of any recommendation.  A clinical trial would have to be done to answer the questions raised by the new findings in the article.  Any subsequent recommendations would be made on analyzing the benefits and risks involved.  The overarching purpose would be to keep the children as safe as possible while giving them the best protection against rotavirus.

So the CDC isn’t saying that women in the United States or anywhere else should stop breast feeding, even for a short period.

No one is recommending that these mothers should stop breastfeeding, even temporarily.  More studies are needed to better understand how breast feeding interacts with rotavirus vaccine before any scientific conclusions can be made.

Again, it is important to point out that there are no recommendations to stop breastfeeding around the time of rotavirus vaccination.

The Arizona Department of Health Services, the Centers for Disease Control and Prevention, and the American Academy of Pediatrics are strong supporters of breastfeeding, and strong supporters of children receiving all recommended vaccines.

RAK Breastfeeding Resources

Smoker in the family? Pediatricians can help

There’s good news on second-hand smoke exposure among middle schoolers and teens, according to a new study issued this week by the American Academy of Pediatricians (AAP).

Data reviewed by the National Youth Tobacco Survey found that second hand smoke exposure decreased among both nonsmoking and smoking kids in grades six through twelve.

Send a "Love your heart- quit smoking" valentine e-card courtesy of the CDC

But there’s also not-so-good news. In 2009, 22.8 percent of non-smoking students and 75.3 percent of smoking students still reported second hand smoke exposure in a car within the past week.

Second hand smoke exposure has deleterious health effects.

According to the Centers for Disease Control, second hand smoke contains around 7,000 chemicals. Around 70 of those chemicals are known carcinogens.

Acute respiratory infections, middle ear disease, delayed lung growth, and more severe cases of asthma increase when the air kids breathe contains smoke from tobacco products.

Voluntary smoke-free policies, or expanding existing comprehensive smoke-free policies that prohibit smoking in worksites and public areas, could reduce second hand exposure in cars, says the AAP.

It can be tough for parents who smoke to limit their children’s exposure to tobacco smoke.

How to become an anti-smoking role model—even if you smoke

And discussing the issue during an office visit can sometimes be tricky, says Dr. Theresa LoCoco, a member of the Arizona Chapter of the American Academy of Pediatrics.

LoCoco, who practices with Pediatric Associates in Phoenix, says she finds it best to remember that both parents and their pediatricians have a common goal-optimum health for their children.

“This opens the door to discuss the risks of second-hand smoke: increased rates of ear infections, allergies, asthma and asthma exacerbations, pneumonia and other upper respiratory tract infections.”

There’s also an association between parental smoking and Sudden Infant Death Syndrome (SIDS) as well as behavioral issues such as ADHD/ADD, says LoCoco.

Kids whose parents smoke are more likely to smoke themselves, increasing the risk for cancer later on in life. 

But quitting smoking is tough.  And while many parents would like to for the health of their child, some are not currently ready or able to so. Sometimes it’s not the parent who smokes, says LoCoco, but instead a close family member or friend who has close contact with the child.

LoCoco advises those parents to try to limit tobacco smoke exposure to their children as much as possible.  This includes never having the child in the car or house with someone who is smoking.

Still, she emphasizes that no amount of exposure to tobacco smoke is considered safe.

Recent research warns of the dangers of “third-hand smoke,” which is exposure to nicotine and other harmful substances in the residue left by tobacco smoke.  This residue can be found on drapes, upholstery, clothing, hair and skin and has many of the same health consequences for children as second-hand smoke.

Limiting this exposure can often times be difficult. LoCoco suggests that a smoker  change clothes and shower or bathe before contact with a child to keep exposure to a minimum.

Kids who are bullied less likely to be physically active

Children who are bullied by their peers endure great emotional pain and suffering.

Staying active has emotional benefits, too. Courtesy YMCA of the East Bay, Oakland, CA

But a new study, to be published in the March 2012 issue of Pediatrics, found that children who are ostracized, even for brief periods, are significantly more likely to choose sedentary over physical activities.

Researchers asked children between the ages of 8 and 12 to play a virtual ball-toss game. They were told that they were playing the game online with other kids. In some of the sessions, the game was pre-programmed to exclude the child from receiving the ball for most of the game.

In the other sessions, the child received the ball one-third of the time. After the game, the kids were given a choice of any activity they liked. They were then monitored by a device that measured physical activity.

The researchers found the kids who were excluded were far more likely to choose an activity that did not require physical effort.  They concluded that being ostracized may reinforce behaviors that lead to obesity in children.

Even though this study seems small, it is important, says Dr. Farah Lokey, a member of the Arizona Chapter of the American Academy of Pediatrics.

Children who are prone to being bullied and then ostracized in school every day tend to spend more time at home and less time participating in activities with other children.

And that can damage self-esteem. “The key to getting these children active, and feeling good about themselves, says Lokey, who practices at Southwestern Pediatrics Gilbert, “is putting them into activities where they can shine on their own and meet like-minded individuals.”

Individual sports such as golf, swimming, and tennis can provide these opportunities, Lokey adds. “These sports not only allow them to become experts in the sports by learning these skills but definitely help their self- esteem and pride.”

Sports like Karate and other self-defense activities encourage treating others with respect. That keeps the concept top-of-mind for children.

When to worry

Younger school-age children typically begin their school years with a sense of excitant about learning and making new friends. But if a child seems suddenly less enthused and more fearful around school, or develops separation anxiety, that could be a red flag that bullying is going on, says Lokey.

Some children will show physical problems with no diagnosable cause, such as a tummy aches – but maybe only on the weekdays, not on weekends. Sleep problems or anxiety in social situations can also be indicators.

With older children, behavior can become more aggressive and defiant, says Lokey. Grades may suffer, and parents may notice a change in appearance as well as a tendancy to seclude themselves from others.

 What to do

If parents do see sudden changes, they should speak to school officials and enlist the help of school counselors. Lokey says that pediatricians can be a great resource when parents have questions about these behaviors.

A child’s physician can talk to their patient in confidence and offer to speak with school counselors if needed. “Bolstering confidence and self-esteem in the children we pediatricians treat,” says Lokey, “is one of our main goals.”