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Parenting, Pediatrics, Research, Stanford News

Reading, book sharing less common in immigrant families, Stanford study finds

Reading, book sharing less common in immigrant families, Stanford study finds

readingA new study from Stanford researchers turns a light toward differences in parent-to-child reading in immigrant and non-immigrant households in the U.S. The results could help explain the gap in language development between certain minority children entering preschool and their peers.

Researchers looked at how often parents read or shared picture books with their children under the age of 6. Published in Pediatrics, the study (subscription required) found that daily book sharing occurred in 57.5 percent of parents in immigrant families and 75.8 percent of native-born parents. Among the households surveyed, book sharing was lowest in Hispanic families and households with both parents foreign-born.

From a Reuters piece:

Parents with low education levels or a low household income were less likely to book share with their kids. But even when those factors were taken into account, immigrant parents were less likely to share books than native-born parents.

Senior author Fernando Mendoza, MD, told Reuters, “This paper just says there is a difference, and not because they’re poor, but because they are immigrants.” A study co-author also noted that “we have a long way to go in understanding what is behind” the findings.

Previously: Learning how we learn to readStanford study shows importance of parents talking directly to their toddler and Imaging study shows little difference between poor readers with low IQ and poor readers with high IQ
Photo by San José Library

Global Health, Nutrition, Parenting, Pediatrics, Research, Rural Health, Stanford News

Seeking solutions to childhood anemia in China

Seeking solutions to childhood anemia in China

Chinese boyHow can health and nutrition education needs in rural China be addressed? Start by examining infant-feeding practices.

Scott Rozelle, PhD, director of the Rural Education Action Program, part of the Freeman Spogli Institute for International Studies (FSI) Center on Food Security and the Environment at Stanford, conducted a study on 1,800 babies in China’s Shaanxi province to address high rates of anemia and cognitive delays in children owing to poor nutrition, though not necessarily lack of funds for healthy food.

A recent piece on the FSI website describes the ongoing study:

One third of households were given a free daily supply of nutritional supplements for their children. Another third were given the same free supplements, and were enrolled in a text message reminder program. A final third of households served as a control group. The study is ongoing through April, 2015, but 12 months into the program, the researchers have found that the supplements have reduced anemia rates by 28 percent, although cognitive delays have persisted.

Text message reminders appear to have been modestly effective in improving program compliance. Caregivers who received the reminders gave their baby the micronutrient supplements, on average, 10 percent more often over the course of the first six months of the study. So far, however, this improved compliance has not led to a corresponding fall in anemia rates.

Rozelle commented in the piece, “To reach all of China’s at-risk babies – that’s our ultimate objective. And to do that, we need an effective government program.”

Previously: Who’s hungry? You can’t tell by lookingFeeding practices and activity patterns for babies vary with families’ race and ethnicity, study shows and Student inventors create device to help reduce anemia in the developing world
Photo by Kris Krüg

Cancer, Fertility, Parenting, Pregnancy, Women's Health

A cancer survivor discusses the importance of considering fertility preservation prior to treatment

pregnancy_testBack in 1998, Joyce Reinecke, JD, was on a cross-country business trip when her increasing fatigue and lightheadedness resulted in her being admitted to the emergency room and the discovery that she had tumors in her stomach, one of which was necrotic and bleeding causing her to be severely anemic. She was diagnosed with leiomyosarcoma, and the tumors, as well as all of the surrounding lymph nodes, were surgically removed. Before she was discharged from the hospital an oncology fellow casually mentioned to Reinecke that since she was scheduled to start chemotherapy she might want to consider options to preserve her fertility.

At the time, Reinecke and her husband hadn’t considered how her treatment would affect their future plans to have a family. The couple eventually decided to complete a round of in vitro fertilization and work with an agency to select a gestational carrier. Their twin daughters were born in February 2000. Reinecke, executive director of the Alliance for Fertility Preservation, shared her patient perspective during a keynote speech at the Family Building After Cancer: Fertility Preservation and Future Options Symposium held at Stanford earlier this month.

To continue the conversation, I reached out to Reinecke about the issue of fertility and cancer survivorship. In the following Q&A, she discusses advancements in the field, why patients need to be proactive in sharing their wishes to have a family with providers, and questions to consider prior to treatment.

What motivated you to focus your career on expanding patient and provider awareness of fertility preservation?

When my girls were around two, I received several inquiries from family acquaintances who had young adults in their lives who were newly diagnosed with cancer. These people had reached out to my parents, to try to understand more about what I had done, where I had gone, etc. in order to preserve my fertility. In speaking to others and hearing about their challenges in finding fertility information and services, I started to really feel that something about the status quo was not right. These patients/family members had learned about possible infertility because they knew of my story, not because their doctors had discussed it with them. This really emphasized to me that my situation – learning about my possible infertility in a very ad hoc way – was not unique, not unusual, but the norm, and perhaps, lucky.

I began doing research around the issue, to see what was out there, what information was available online, etc. I found very little, but I did stumble upon information that Fertile Hope was having a fundraiser. I was in complete shock that a new nonprofit focused on this very issue existed, not to mention that it was based in New York. I went to the fundraiser, signed up to volunteer, met with Lindsay Beck, and signed on as Employee #2. The rest is history.

A past study shows that less than half of U.S. physicians are following the American Society of Clinical Oncology’s guidelines suggesting all patients of childbearing age be informed about fertility preservation. How can patients make sure they get the necessary information about their fertility options prior to treatment?

This question is tricky, because I feel like the onus for initiating this discussion has to be on the provider. Newly diagnosed patients are overwhelmed with all sorts of medical information and decisions to make, not to mention the emotional distress of the diagnosis. Also, patients don’t know what they don’t know. Sometimes providers mistakenly believe a patient isn’t interested in fertility preservation because they don’t ask about it. However, providers have to remember that newly diagnosed young adults probably have very little understanding about how chemotherapy and radiation work – unless they have a cancer that has a direct impact on their reproductive system they probably have no inkling that their fertility is at stake.

That being said, patients need to advocate in their own interest (or enlist a family member to help them do this if they cannot during this difficult time). That means communicating their wishes and values about future parenthood with their providers. That means asking the right questions: Will I be able to have children in a few years? Ever? What can I do about it? It might also mean being able to challenge their doctor’s disapproval or ask that treatment be pushed back [so the patient has time to] bank sperm or eggs. Which is sometimes hard to do.

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Parenting, Pregnancy, Stanford News, Women's Health

A team of high-risk birth specialists intervene to remove a large lung cyst and save a newborn’s life

A team of high-risk birth specialists intervene to remove a large lung cyst and save a newborn's life

baby-elijah-fetal-maternal-stanford-childrens-200x200When Elizabeth Rodriguez-Garcia was six months pregnant with her first child, she received some frightening news about the development of her baby: The fetus had a large, fluid-filled cyst that was impeding growth of his lung, compressing on his esophagus and pushing on his heart. As the cyst grew larger, the baby developed fluid retention, a condition known as hydrops, and was at high risk of dying in utero.

A Lucile Packard Children’s Hospital Stanford press release explains how a team of high-risk birth specialists collaborated to intervene both before and after delivery to save the newborn’s life:

A week after the cyst was first found, Jane Chueh, MD, director of prenatal diagnosis and therapy at the hospital’s Johnson Pregnancy and Newborn Center and a clinical professor of obstetrics and gynecology at the School of Medicine, inserted a large needle into Elizabeth’s abdomen and into the fetus’ chest using ultrasound guidance, then threaded a small rubber shunt through the needle into the cyst. It was the first use of the procedure at Lucile Packard Children’s Hospital Stanford.

“It immediately started to drain,’’ Chueh said. “It’s like popping a water balloon. Most of the fluid came out in seconds.”

Relieving pressure from the cyst came at a critical time, said Chueh. The dangerous fluid retention that doctors worried was endangering the baby’s life improved dramatically.

After the intervention, mother and baby continued to be frequently monitored and it soon became clear that an emergency surgery would be necessary after delivery to make sure the newborn could breathe properly on his own. At 39 weeks, Rodriguez-Garcia had a scheduled C-section to simplify the transition between delivery and surgery. Nearly three dozen surgeons, obstetricians, anesthesiologists, neonatologists and respiratory therapists worked quickly to ensure mom and baby’s safety:

The operating team, led by surgeon Karl Sylvester, MD, the center’s executive director as well as an associate professor of pediatric surgery, stood by. Within minutes of birth, the baby was quickly moved into Sylvester’s operating room, where he and the surgical team, including assistant professor of pediatric surgery Matias Bruzoni, MD, removed both the cyst and more than two-thirds of the baby’s lung that was adversely affected by the cyst.

“Our ability to provide all these subspecialists in two rooms to care for both the mom and the baby is what led to the successful outcome for this family,” Sylvester said. “It made a huge difference in this young family’s life; without it, he may not have survived at all.”

Today, Rodriguez-Garcia and her husband have a happy, healthy 5-month-old named Elijah. His mother said, “If you see him, you’d never know what he went through and that he doesn’t have most of his left lung. The cyst is completely gone. I feel blessed.”

Previously: From womb to world: Stanford Medicine Magazine explores new work on having a baby, Special care to protect newborns’ fragile brains and A family’s grace in crisis

Complementary Medicine, Mental Health, Parenting, Pregnancy, Research, Women's Health

Ah…OM: Study shows prenatal yoga may relieve anxiety in pregnant women

Ah...OM: Study shows prenatal yoga may relieve anxiety in pregnant women

Desi_smallDuring a pre- and postnatal yoga module of my yoga teacher training, I was enchanted by instructor Desi Bartlett‘s reference to “pregnant goddesses” – our future students – as we learned how yoga could help them prepare for delivery day. (Think deep squats.) Methods to empower goddesses throughout and beyond pregnancy included modifications to traditional poses to stay fit while providing a safe “house” for the fetus, breathing and meditation to steady a busy mind, group activities to build community with other new parents and restorative poses to find calm during a period of change.

Now, a study (subscription required) has investigated how yoga can help relieve pregnancy-specific anxiety in mothers-to-be. Researchers at the University of Manchester and Newcastle University in the U.K. followed 59 women, each pregnant with her first child and receiving normal prenatal treatment during the late second to third trimester, and asked them to self-report their emotional states. A randomized group attended eight weekly prenatal Hatha yoga sessions, and researchers measured those participants’ saliva cortisol levels before and after the first and last classes of the intervention.

From a release:

A single session of yoga was found to reduce self-reported anxiety by one third and stress hormone levels by 14%. Encouragingly, similar findings were made at both the first and final session of the 8 week intervention.

“The results confirm what many who take part in yoga have suspected for a long time,” John Aplin, PhD, one of the senior investigators in Manchester and a yoga teacher, said in the release. “There is also evidence yoga can reduce the need for pain relief during birth and the likelihood for delivery by emergency caesarean section.”

The study was published in the Journal of Depression and Anxiety.

Previously: Toilets of the future, and the art of squattingA reminder that prenatal care is key to a healthy pregnancyPregnant and on the move: The importance of exercise for moms-to-be and Ask Stanford Med: Pain expert responds to questions on integrative medicine
Photo of Desi Bartlett by Natiya Guin

Obesity, Parenting, Pediatrics, Research

Feeding practices and activity patterns for babies vary with families’ race and ethnicity, study shows

Feeding practices and activity patterns for babies vary with families' race and ethnicity, study shows

4361756526_774638516a_zWhen and how does childhood obesity begin? The question is a big challenge for researchers, who have observed that more than a quarter of US children aged 2 to 5 are now obese. That’s worrying because of links between obesity, heart disease and diabetes.

To help find answers, a new study is following babies and their parents from age 2 months to 2 years, tracking the babies’ growth and the families’ habits around feeding and activity for their little ones. Researchers at four centers around the country have recruited more than 800 baby-parent pairs to participate. The subjects are ethnically diverse and come mostly from low-income households, with 86 percent receiving Medicaid.

Today in Pediatrics, the scientists report the first findings from the project, an analysis of baseline data collected when the babies were 2 months old. The researchers found striking differences in feeding practices and activity patterns along racial and ethnic lines, suggesting that perhaps future efforts to prevent childhood obesity should be culturally tailored for different groups. Stanford’s Lee Sanders, MD, is one of the authors of the new paper, though none of the data was collected at Stanford.

Among the findings, Hispanic parents were more likely to encourage babies to finish a bottle and reported less tummy time than white parents; black parents were more likely to put babies to bed with a bottle, prop a bottle in front of a baby with a blanket (instead of holding it as the baby ate), and reported more TV watching for their babies than white parents. The differences persisted after the data was adjusted for possible confounding factors such as family income. It’s not clear whether all of these behaviors will be connected to higher obesity rates, but later reports from the same study will give more information about that.

In the study’s discussion, the researchers write:

If these behaviors are truly “obesogenic,” however, families from all races and ethnicities studied need early counseling, and the findings here also underscore the likely need for culturally sensitive health behavior counseling during early infancy. Particularly actionable are the specific behaviors that may be most sensitive to culturally adapted interventions: (1) infant exposure to television and other visual media; (2) breastfeeding initiation and exclusivity; and (3) encouraging infants to finish bottles.

Previously: Childhood obesity a risk for imminent heart problems, research shows, Sugar intake, diabetes and kids: Q&A with a pediatric obesity expert and Nutrition and fitness programs help East Palo Alto turn the tide on childhood obesity
Photo by dogs & music

Parenting, Patient Care, Pediatrics, Stanford News

Children’s hospital volunteers snuggle infants to soothe tiny patients and reassure their parents

Children's hospital volunteers snuggle infants to soothe tiny patients and reassure their parents

Calling all cuddlers! As previously written about here and in the most recent  Stanford Medicine Newsletter, volunteers Pat Rice and Claire Fitzgerald have been holding and soothing infants at Lucile Packard Children’s Hospital Stanford for 16 years, providing comfort both to the tiny patients and their parents. Rice and Fitzgerald, Ronald Cohen, MD, and sweet babies were featured on ABC’s World News with Diane Sawyer in the segment above.

Previously: Paying kindness forward through infant-cuddling“I opened the doors:” A look back at two special babies and Neonatologist celebrates 50 years of preemie care

In the News, Parenting, Pediatrics, Sleep

Study: Baby sound machines may be too loud for little ears

Study: Baby sound machines may be too loud for little ears

DSC_0293Sound machines that help babies sleep more soundly are a staple on many new parents’  baby registries (I had a little sheep that mimicked the sounds of rainfall and ocean waves). Well, as you may have read about elsewhere today, a new study published in the journal Pediatrics finds those soothing sounds may actually do more harm than good. Researchers from the Hospital for Sick Children in Toronto have found that infant sleep machines can reach sound levels that are hazardous to infant hearing and development. Writer Michelle Healy outlines their findings in an article in USA Today:

When set to their maximum volume:

– All 14 sleep machines [studied] exceeded 50 decibels at 30 cm and 100 cm, the current recommended noise limit for infants in hospital nurseries.

– All but one machine exceeded that recommended noise limit even when placed across the room, 200 centimeters away.

–Three machines produced outputs greater than 85 decibels when placed 30 cm away. If played continuously, as recommended on several parenting websites, infants would be exposed to sound pressure levels that exceed the occupational noise limits for an 8-hour period endorsed by the National Institute for Occupational Safety and Health and the Canadian Centre for Occupational Health and Safety.

It’s important to note that the researchers only tested the maximum output levels produced by the sound machines, and not their direct effect on infants. But Nanci Yuan, MD, tells Healy that the study does raise some important concerns:

​Parents “can feel desperate and want to try anything” when a baby has difficulty sleeping, says Nanci Yuan, pulmonologist and sleep medicine specialist at Lucile Packard Children’s Hospital Stanford.

But this research highlights the potential for a previously “unknown harm that can occur,” Yuan says. “We’re getting more and more concerned about issues related to sound and noise and hearing-loss in children because it’s progressive.”

Photo by Margarita Gallardo

Parenting, Patient Care, Pediatrics, Stanford News

One family’s story caring for their children with type 1 diabetes

One family's story caring for their children with type 1 diabetes

diabetesFamily members may share a set of values, a sense of humor, or various personality traits. And sometimes members of a family have a health condition in common. The recent Stanford Medicine Newsletter features a San Jose, Calif. family with five children – two of whom have type 1 diabetes and a third who has been identified as likely to develop it in the next two years. The Bergh family receives care for their children at Lucile Packard Children’s Hospital Stanford.

From the piece:

Roughly 5 percent of families who have one child with diabetes will have a second child with the disease, but it’s unusual to have three, according to Bruce Buckingham, MD, professor of pediatric endocrinology at Lucile Packard Children’s Hospital Stanford and the School of Medicine.

Buckingham, who treats the Bergh children, assessed everyone in the family for the disease by testing for antibodies that can generally predict when a child is going to develop diabetes. Four months after Maleki got his diagnosis, Marae tested positive for the antibodies. She did not get the disease for five more years, but by then Tierra Bergh [the mom] knew what to do. After noticing that Marae was drinking and urinating excessively one weekend, she used her son’s glucose meter to test Marae’s glucose levels and immediately called Buckingham.

“I was devastated,” she recalled, “but Dr. Buckingham was very calm. He said, ‘You already know how to take care of a child with diabetes.’”

Previously: A tale of two Shelbys: The true story of two diabetes patients at Lucile Packard Children’s Hospital and Tips for parents on recognizing and responding to type 1 diabetes
Photo courtesy of Bergh family

 

Parenting, Stanford News, Videos

Stanford patient celebrates son’s first birthday with help of her care team

Stanford patient celebrates son's first birthday with help of her care team

This touching video is a must-watch. The piece focuses on a young mom whose serious illness has kept her hospitalized for more than a month. When the patient’s care team learned of her son’s first birthday, they sprang into action and threw the little boy a party right then and there – ensuring that his mom wouldn’t miss this most important milestone.

“Some patients tug at your heart,” Hirut Truneh, the unit’s patient care manager, told Stanford Hospital’s Sara Wykes, who produced the video alongside Todd Holland. The video certainly tugged at mine.

Stanford Medicine Resources: