Researchers at UW studied the reaction of nearly 100 toddlers, 18 months old, in response to someone playing with a toy while either being emotionally or non-emotionally addressed by a second adult. The researchers wanted to determine if the actions of the toddler could be influenced by the emotional expression of adults.

They found that indeed, toddlers will learn and model behavior based on the emotions, actions, and reactions of adults around them.

After observing an adult playing with a particular toy, each of the toddlers interests were sparked. But if a second adult entered the situation and addressed the first adult in a heated or emotional manner, the child was more apprehensive about playing with the toy when left alone. And once the child began to play with the toy, if the emoting adult entered the room again, the child quickly put it down.

Where as if the second adult was non-emotional, the child was more quick to play with the toy when left alone and did not show similar behavior when the emoter re-entered the room.

Infants facial expressions were also studied and the researchers found that they may not respond to anger or angry expression but they are gathering information about the emotional expression, perhaps to later influence their own behavior.

The study was published in the March issue of Child Development and gives more insight to the early personality development in children and how interpersonal communication and skills are influenced at a very early age.

The authors conclude that parents need to be aware of their actions with older siblings because the younger children may be picking up more than they bargain for.

A new study, published in the Lancet, found conflicting evidence. The study was conducted in South Africa, an area hit hard by the AIDS epidemic. Moret han 1,300 mother-infant pairs enrolled in the study and were followed up to 6 months of age.

The researchers wanted to know how nutrient sources affected HIV status and overall morbidity in the infants with HIV+ mothers. The women in the study either exclusively breastfed, gave only infant formula, or did a combination of the two. A subset of mothers also fed their children solid foods.

They found that infants who were exclusively breastfed thru 6 months of age had a lower rate of transmission compared to infants given formula, solid foods, or a combination of formula, solids, and breastmilk.

Only 4 percent of infants with HIV+ mothers transmitted HIV during the first six months. This is half the rate of those babies either fed exclusively formula or a combination. And if the infants were given solid foods in additon to breastmilk and/or formula the rate of transmission was 11 times that of exclusively breastmilk fed babies.

They also found that the death rate of the infants fed exclusively breastmilk at 3 months was half that of infants fed only formula, 6 percent compared to 15 percent respectively.

The authors commented that breastmilk may help to protect these infants by providing antibodies to bacteria and viruses, including HIV. The breastmilk may also contain specific compounds that re-inforce the complex barrier in the GI system that keeps out harmful microorganisms.

Researchers followed more than 130,000 children born to parents in the Kaiser Permanente system between 1995 and 1999. A total of 593 children were diagnosed with an Autistic Spectrum Disorder, ASD, which includes autism. Then both maternal and paternal age were coorelated with autism incidence.

Previous studies had found some link between paternal age and autism rates, though the relationship was not relatively strong.

They found that as age increased, risk of having an autistic child increased. The increase was most evident for female children. For every decade increment increase in age the risk rose 31 percent for maternal age and 28 percent for paternal age.

Based on these results a larger study is underway involving the majority of births in California to see if the link is still present in the general population.

The randomized, double-blind study, published in The Lancet, investigated the effectiveness of zinc in preventing the risk of death in young children. Researchers at the Johns Hopkins Bloomberg School of Public Health administered either 10 milligrams zinc or a placebo daily to 42,546 children aged 1 to 36 months, for over one year. Children younger than 12 months were given 5 milligrams zinc. The children were from Pemba, Zanzibar, an area known for malaria.

The researchers found that zinc supplementation reduced overall deaths by 7 percent. However, children ages 1 to 4 who received zinc reduced the risk of death by 18 percent. Reduced benefits were seen in children aged 12 months or younger. The study suggests that children younger than 12 months may have received sufficient zinc in utero and from breastfeeding.

"We believe that a meta-analysis of all studies of mortality and morbidity, will help to make evidence-based recommendations for the role of zinc supplementation in public health policy to improve mortality, morbidity, growth, and development in young children," the study authors conclude.

REFERENCES:
1. Sazawal S et al. Effect of zinc supplementation on mortality in children aged 1-48 months: a community-based randomised placebo-controlled trial. Lancet 2007 Mar 17;369(9565):927-34.

Many of the effects are long term, and some may be life threatening. While others may be reversible or partially correctable.

A recent animal study published in the journal Behavioral Science found that the nutrient choline may help to reverse some of the damage to the brain caused by alcohol.

Researchers at San Diego University studied mice to understand the effect of choline on brain development after exposure to alcohol. Choline is known to affect brain development via the neurotransmitter acetylcholine.

In the lab pregnant mice were fed alcohol to induce FAS in their offspring. Then some of the pups were given choline after birth. Characteristics and activity were observed in both the pups given choline and those not and compared.

All pups born to mice given alcohol exhibited hyperactivity and learning problems. In the pups given choline, these characteristics improved over time.

The authors state that choline should not be an easy out for women to drink alcohol during pregnancy. Especially because FAS includes several serious conditions that are not affected by choline and could be life threatening.

Choline is found naturally in foods including peanuts and peanut butter, iceberg lettuce, and soy products. Many of the prenatal vitamins contain choline as do baby formulas and children's food and supplements.

The authors recommend that women take 450 mg of choline while pregnant and 550 mg while breastfeeding, regardless of whether they consume alcohol or not.

Rotavirus is the number one cause of diarrhea in the US and the world. In the US more than 400,000 cases of diarrhea are attributed to the virus. More than 50,000 cases will need hospitalization due to the severe dehydration that can occur.

The RotaTeq vaccine is approved for infants age 2, 4, and 6 months. It is an oral vaccine. After its inception this year a high number of intussesception cases were reported in infants recently given the vaccine.

Intussesception results in bowel obstruction after the intestine twists and telescopes into itself. It can be treated without complications in early stages, but if missed often bowel perforation, infection, and even death can occur.

In response the FDA issued a warning for healthcare providers to be aware of possible complications. But they did not pull the vaccine because the relationship was not clear. Both the FDA and CDC launched an investigation to determine if the vaccine was safe for infants.

They have concluded that the cases of intussesception did not exceed the usual number of cases in the general population and that the vaccine administration is not connected to the intussesception cases that were reported.

A British study was published last month in the Journal of Clinical Endocrinology and Metabolism investigating the relationship between a mothers fitness level and body composition with her infants birth weight. A total of 448 women were enrolled prior to pregnancy and followed until delivery.

Each of the women recorded diet and lifestyle habits before and throughout the pregnancy. The researchers also recorded weight, height, and body composition. Birthweight was measured in infants shortly after birth.

They found that women who were less fit, as measured by speed of walking, had larger babies. Women with a greater percentage of body fat also had babies with more body fat compared to lean women.

Babies born to mothers who have poor weight gain also suffer, with low birth weight. A finding not related to obesity later in life, but still significantly effects long term health.

The study, published in the British Medical Journal, examined the effect of folic acid supplementation during pregnancy in the prevention of cleft lip. Researchers at the National Institute of Health (NIH) analyzed the data of 377 infants with cleft lip with or without cleft palate, 196 infants with cleft palate, and 763 healthy infants, born between 1996 and 2001 in Norway. Questionnaires were obtained from the infants' mothers and analyzed for dietary folates, multivitamins and folic acid supplements during pregnancy.

The researchers found that 400 micrograms or more of folic acid supplementation daily during early pregnancy was linked with a 39 percent reduced risk of cleft lip in newborns. Dietary folate alone was linked with a 25 percent reduced risk of cleft lip. However, women who supplemented with folic acid and multivitamins along with dietary folate, had a 74 percent reduced risk of cleft lip in their infants.

"Folic acid supplements during early pregnancy seem to reduce the risk of isolated cleft lip (with or without cleft palate) by about a third," the study authors conclude. "Other vitamins and dietary factors may provide additional benefit."

REFERENCES:
1. Wilcox AJ et al. Folic acid supplements and risk of facial clefts: national population based case-control study. BMJ 2007 Mar 3;334(7591):464. Epub 2007 Jan 26.

The double-blind, randomized, placebo-controlled study, published in Archives of Disease in Childhood (Fetal and Neonatal Edition), examined the effect of fish oil supplementation on child development. Researchers at the University of Western Australia in Australia administered 5 grams of fish oil (containing 2.2 grams DHA and 1.1 grams EPA) or a placebo daily to 98 pregnant women, from the twentieth week of pregnancy until delivery. Mental development, language, behavior and hand-eye coordination tests were obtained from their children at 2 1/2 years old.

The researchers found that 33 children of the women in the fish oil group had significantly higher scores for hand and-eye coordination, than 39 children of the women in the placebo group. Better eye hand coordination scores were linked with higher cord blood levels of omega-3 fatty acids and lower levels of arachidonic acid (omega-6 fatty acids). However, growth measurements were similar for both groups of children.

"Maternal fish oil supplementation during pregnancy is safe for the fetus and infant, and may have potentially beneficial effects on the child's eye and hand coordination," the study authors write. "Further studies are needed to determine the significance of this finding."

REFERENCES:
1. Dunstan JA et al. Cognitive assessment at 21/2 years following fish oil supplementation in pregnancy: a randomized controlled trial. Arch Dis Child Fetal Neonatal Ed. 2006 Dec 21; [Epub ahead of print].

The study, published in the British Medical Journal, investigated the effectiveness of milk fortified with micronutrients in disease prevention among young children in northern India. Researchers at the Johns Hopkins Bloomberg School of Public Health and the Center for Micronutrient Research at Annamalai University in India, administered milk fortified with zinc, iron, selenium, copper, vitamin A, vitamin C and vitamin E or unfortified milk to 633 children, ages 1 to 4, for one year. The children were followed twice a week to obtain information regarding illnesses that may have occurred.

The researchers found that the children who consumed the fortified milk reduced the risk of severe illness by 15 percent, the risk of pneumonia by 16 percent, and the risk of diarrhea by 18 percent, compared to those consuming unfortified milk. Greater benefits were seen in children aged 2 or younger.

"Milk is well accepted as a means of delivery of micronutrients," the study authors conclude. "Consumption of milk fortified with specific micronutrients can significantly reduce the burden of common morbidities among preschool children, especially in the first two years of life."

REFERENCES:
1. Sazawal S et al. Effects of fortified milk on morbidity in young children in north India: community based, randomised, double masked placebo controlled trial. BMJ 2007 Jan 20;334(7585):140. Epub 2006 Nov 28.

Several of the updates involve changing recommendations for vaccines already in use by certain pediatric populations while other are new vaccines.

The new recommendation for the Varicella vaccine is additon of a booster between the ages of 4-6. Varicella is a rather new vaccine on the schedule and originally the CDC only recommended one injection after 2 years of age. But recent studies on the efficacy found lower than expected immunity rates with only one injection, so a booster is being added to the schedule.

The flu vaccine is now approved for infants age 6-59 months. Previous years recommendations only covered children age 5 and above. Because the flu can be very severe in an infant, progress has been made to make the vaccine more safe for infants as young as 6 months. The flu vaccine should be given once a year, usually in the fall months to cover the coming flu season.

A vaccine for rotavirus has been approved and added to the recommendations for infants age 2,4, and 6 months of age. Rotaviruses are responsible for most cases of severe diarrhea in infants and can result in severe dehydration and death. If all three doses are received, protection should sufficient through early childhood (age 5).

The final addition is for the Human Papillomavirus (HPV). Girls age 11-12 years should be given the first dose of the HPV vaccine. The primary goal of the vaccine is to prevent the spread of HPV, in particular the strains most associated with cervical cancer in women. Currently only one injection is recommended. If girls between the ages of 11 and 12 miss this vaccine it can be offered till age 18.

It is common for the American Academy of Pediatrics to review the available vaccines and to change recommendations based on disease trends and safety. Your healthcare provider should be able to answer any questions you have about any of these or other vaccine as well as help to determine if any of your children may need to 'catch-up' on these or other vaccines.

To test this possible relationship researchers at South Dakota State University enrolled 173 children age 3 to 5 years old into a clinical trial. Children were randomized to receive a daily calcium supplement or placebo for one year. Body fat percentage, weight, and calcium levels were monitored during the study period and compared to baseline.

The results, published in the American Journal of Clinical Nutrition found no relationship between calcium intake and body fat percentage.

Children who were taking the calcium supplement did not show any difference in body fat percentage compared to children not on the supplement. There was one small exception, a group of children who were calcium deficient and receiving a supplement showed a slight decrease in fat mass compared to others. But this relationship was not strong enough to warrant further studies or to suggest that children start taking a calcium supplement.

Most children are not deficient in calcium because of the consumption of dairy products and fortification in other foods. The average recommended daily intake of calcium for children is 500-800 mg per day depending on age.

The study, published in the American Journal of Respiratory and Critical Care Medicine, examined whether dietary vitamin E during pregnancy affected the risk of asthma in young children. Researchers at the University of Aberdeen in the UK, analyzed the data of 1,253 mothers and 1,120 of their children. Food frequency questionnaires obtained from the mothers at the beginning of the study were analyzed to determine dietary and supplemental vitamin E intake. Five years later, food frequency questionnaires were completed by the mothers for their children. Respiratory and skin-prick testing were also obtained from the children at this time.

The researchers found that higher maternal vitamin E intake during pregnancy was linked with a lower risk of asthma in children. Children were five times more likely to develop asthma if mothers were in the lowest 20 percent of vitamin E intake. Findings also revealed that higher maternal zinc intake during pregnancy was linked with a lower risk of asthma in children. However, the children's vitamin E intake didn't appear to be linked to asthma.

"Maternal intake of foods containing vitamin E and zinc during pregnancy is associated with differences in the risks of developing childhood wheeze and asthma," the study authors conclude.

REFERENCES:
1. Devereux G et al. Low maternal vitamin E intake during pregnancy is associated with asthma in 5-year-old children. Am J Respir Crit Care Med 2006 Sep 1;174(5):499-507. Epub 2006 Jun 8.

A study published recently in the journal Obesity found that moderate exercise alone is enough to reduce snoring in children.

Snoring is associated with obesity, but it is unclear which is the primary cause. Being overweight can lead to snoring by compressing the airways, but snoring and getting inadequate rest can also cause fatigue and contribute to weight gain.

In addition, children who snore can develop learning disabilities because of lack of rest, and some may even exhibit symptoms similar to ADHD.

The study, conducted at the Medical College of Georgia, enrolled 100 overweight children and randomized them to one of three groups. The first group received forty minutes of exercise per day, the second twenty minutes, and the third group did not perform any additional physical activity.

At onset of the study more than 25 percent of parents reported some snoring in their offspring.

At conclusion of the study more than half of the children who snored and were in either of the exercise groups reported resolution. Results were even better in the group who did forty minutes a day.

And the authors stated that weight loss was not a factor in the resolution of snoring, so some other mechanism was causing this effect.

At any rate, a moderate amount of exercise alone was enough to cause resolution of snoring in more than half of the overweight children in this study. It is such a minor activity that may have positive effects on performance in school, development, growth, and general well being.

The study, published in the Journal of the American Academy of Child and Adolescent Psychiatry, investigated the safety and effectiveness of Ritalin (methylphenidate) treatment on 3- to 5-year-old children with ADHD. NIMH researchers administered either generic Ritalin or a placebo to 183 children between the ages of 3 and 5, in four different phases for 70 weeks. The researchers recorded vital signs from the participants and adverse events from parents and teachers. The children's parents attended 10 two-hour ADHD training sessions and had the option to discontinue Ritalin treatment at any time.

The researchers found that Ritalin had positive effects in about 50 percent of the children. However, 30 percent of parents reported adverse events in their children including emotional outbursts, trouble sleeping, repetitive behaviors and thoughts, appetite loss, and irritability. Twenty-one children were discontinued from the drug due to adverse events. These results suggest that Ritalin was not as effective as seen in older children, and had more side effects.

"Eleven percent of preschoolers discontinued treatment because of intolerable methylphenidate adverse events," the study authors write. "Of the serious adverse events reported, one occurred in baseline, two in lead-in, three in titration, one in parallel, and one in maintenance. Only one was possibly related to methylphenidate."

REFERENCES:
1. Wigal T et al. Safety and tolerability of methylphenidate in preschool children with ADHD. J Am Acad Child Adolesc Psychiatry. 2006 Nov;45(11):1294-303.