Parenting

I don’t have personal experience with food allergies – the most I’ve been affected by the rising numbers of pediatric cases is that I’ve never been able to send my daughters peanut-butter sandwiches to school – but I was nonetheless moved by a MomsRising blog entry on the topic today. In it, a mom shares her anxiety about her young son, who has a life-threatening peanut allergy, starting elementary school. She writes:

I always remind myself (and others) to consider likelihood. What is the likelihood of [insert horrible, devastating thing here] actually happening? There is about a zero percent chance of my child being killed in a school shooting incident. I cannot possibly fathom the anguish that those Sandy Hook families experienced and I certainly don’t want to tempt fate, but I have a limited amount of energy for worry, so I choose not to expend it on the minuscule chance that my child will be shot at school.

What is MUCH more likely, though, and is as life-threatening as if someone pointed a gun at my child’s head, is the chance that my son will eat something with peanuts in it while he’s away from me at school. That’s the fear that keeps me up at night. That’s the stress that eats away at my nerves and at the lining of my stomach.

My son is still eighteen months away from starting school. For now, all I can do is read. And worry. And read. And worry. I’m a do-er. I’m black and white. I want to take action. Fix  it. Call the school. Ask questions. Demand answers. But we’re still eighteen months away. So I read.

Previously: Ask Stanford Med: Pediatric immunologist answers your questions about food allergy research, A mom’s perspective on a food allergy trial, Searching for a cure for pediatric food allergies, Helping kids cope with allergies, Peanut bans: An overreaction to food allergies? and What’s causing all those food allergies?

In a recent thought-provoking guest post on the NeuroTribes blog, autism activist Brenda Rothman discusses her personal journey coming to terms with her son’s diagnosis of autism and shares what she’s learned from him. In order to provide better support to autistic people and their families, she argues that society’s perspective of the neurological condition needs to shift from “awareness” to “acceptance:”

We need to challenge how autism is defined — as a set of behaviors and deficits – because this description leads us inexorably to “fixing” autistic people.  Autism is a way that the brain takes in, processes, and responds to information.  This way of processing results in variations in the way the world is experienced and the ways that learning, communication, and movement occur.  Autistic people develop skills on a different timetable or in a different order than expected.

But autism also comes with a set of strengths – a deep passion for interests, the ability to recognize visual, musical, social, or emotional patterns, and a strong individuality.  When we ignore autistic strengths, we ourselves become stuck on fixing autistic people, rather than building on their natural talents.

…

We need to examine our response to autism.  When we start with the incorrect premise that autistic people don’t understand or misbehave, we end up with behavioral programs directed at training them to act in “normal” ways.  By recognizing that they already communicate and understand, we can identify the obstacles that make it difficult for them.  We can move from trying to fix the person to giving them the supports they need.  These supports include sensory-friendly environments, devices to assist communication, acceptance of moving around and stimming, and methods of learning that come most naturally to them. Creating supports like this are like building ramps for autistic people, instead of forcing them to climb stairs that exhaust and exclude them.

The full entry is worth a read.

Previously: New public brain-scan database opens autism research frontiers, New imaging analysis reveals distinct features of the autistic brain and Using music to improve communication skills in children with neurodevelopmental disorders

Food allergies affect millions of children, who find it difficult to enjoy ordinary activities like birthday parties and restaurant meals because of worries that something they eat could send them into anaphylactic shock. As the New York Times described recently, Stanford scientist Kari Nadeau, MD, PhD, is studying how to desensitize children to their allergy triggers. Here on Scope, she recently took questions on food allergies and her desensitization research.

Many readers asked how they could enroll in Nadeau’s research or in similar allergy treatment trials near their homes. Information for prospective study subjects around the world is available here; enter “food allergy” in the “Search for Studies” field, and after searching, click the “On a Map” tab to see trials grouped by location. For those who live near Stanford, go here for details on participating in Nadeau’s research.

Below are Nadeau’s responses to a selection of questions submitted using the hashtag #AskSUMed the comments section on Scope. As a reminder, Nadeau’s answers are meant to offer medical information, not medical advice. They’re not meant to replace the evaluation and determination of your doctor, who will address your specific medical needs and can make a diagnosis and provide appropriate care.

@vikas_aditya asks: What’s the simplest way to identify the cause of an allergy in kids?

If you suspect an allergy to a specific food or environmental cause, skin prick testing is the simplest and least invasive way to initially identify the allergy but it is not the gold standard. A food challenge in the doctor’s office is the true way to test for food allergies.

Elizabeth P. asks: Is there anyone working to find the exact cause of why so many children, teens and adults are developing life-threatening food allergies today? On a related note, @ceband asks: What do you think of the theory that altered gut microbiomes have led to the rise in allergies and autoimmune disease?

Many scientists and researchers are trying to understand the rising prevalence of food allergies in children. Though there are many theories regarding the increase in this prevalence, we still lack definitive answers. Hypotheses have focused on hygiene, dietary fat, antioxidants, vitamin D and dual-allergen-exposure. Altered gut microbiomes might play a role. It does not appear that genetically modified foods are directly linked to food allergies.

Julie Barnes asks: I am currently pregnant and am wondering if I will possibly be creating a food allergy in my unborn child if I avoid all dairy and egg while pregnant and breastfeeding.

There is recent evidence that a diet in pregnancy and during breastfeeding that is high in Vitamin D, follows features of a Mediterranean diet and includes probiotics may be helpful to prevent asthma and allergies. And a healthy, balanced diet is important to your overall health and the health of your baby. However, we do not have evidence that mothers will create food allergies by food avoidance in pregnancy or breasfeeding. Similarly, there is no evidence from the general population that mothers can create food allergies by eating certain foods during pregnancy or breastfeeding.

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Last week, my co-worker had to ask me if I was okay after hearing me sneeze and blow my nose every 15 minutes. I immediately chalked it up to allergies and took some antihistamines. The sneezing stopped, but for the next few days I still had a runny nose and developed a sore throat. So deciding it must be the sniffles and not seasonal allergies, I tried some cold meds this time around.

Because symptoms for a cold and allergies can be very similar, choosing which medication to take can be difficult and confusing. The U.S. Food and Drug Administration is stressing the importance of paying attention to the active ingredients in medications, especially when it comes to treating kids – as mixing drugs can cause adverse reactions or serious health complications. From an agency news release:

Many medicines have just one active ingredient. But combination medicines, such as those for allergy, cough, or fever and congestion, may have more than one.

Take antihistamines taken for allergies. “Too much antihistamine can cause sedation and—paradoxically—agitation. In rare cases, it can cause breathing problems, including decreased oxygen or increased carbon dioxide in the blood, Sachs says.

“We’re just starting allergy season,” says Sachs. “Many parents may be giving their children at least one product with an antihistamine in it.” Over-the-counter (OTC) antihistamines (with brand name examples) include diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton), clemastine (Tavist), fexofenadine (Allegra), loratadine (Claritin, Alavert), and cetirizine (Zyrtec).

But parents may also be treating their children for a separate ailment, such as a cough or cold. What they need to realize is that more than one combination medicine may be one too many.

“It’s important not to inadvertently give your child a double dose,” Sachs says.

Via HealthDay
Previously: CDC launches campaign to reduce accidental drug overdoses among children and New ways to prevent drug overdoses in children
Photo by anjanettew

We’ve written here about the food-allergy work being done by Kari Nadeau, MD, PhD. But what’s it like for the parents of children with severe allergies who participate in one of Nadeau’s trials? As the kids are gradually exposed to foods they are highly allergic to, how do their moms and dads feel? That was the focus today of an NBC online piece, which includes excerpts from e-mails written by a mom of one study participant. A few of the passages jumped out at me:

January 27, 2012: Tessa will officially start the clinical trial at Stanford Hospital Friday morning!

This journey we are about to embark on is a massive one … and not to be underestimated. Not only is the time commitment great … this will be physically and emotionally taxing on Tessa as well. It will be scary for her (and us) at times as she will be reacting to the foods all throughout. Kids can have anything from stomachaches to hives to vomiting, etc.

We were in bed tonight and [Tessa] said “Mommy, I am scared. What if I can’t tell that I am having a reaction and it gets out of control like the last two times when I almost died?” It was a heart-wrenching conversation.

…

February 26, 2012: Tessa is now up to the equivalent of …  about one ounce of milk, four peanuts, [and] three whole crackers.

She has now had three home doses at this level and has not even had the slightest reaction (knock on wood) … I watched her eating crackers with her friends the other day … which was a very weird sight to see her eating “normal” food socially like that among friends… and had to make sure that her friends were very clear that she is only able to eat this food because of the drug she is on [Xolair, which suppresses the allergic reaction].

Mentally she is doing very well, too … In fact, she is the one that keeps telling me to “chillax”.

…

April 10, 2012: … There were a few extra M&M’s on the side and Tessa asked me to eat them and I said, “No thank you” and she insisted that I eat them. It was the first time in nine years that I have ever eaten anything “unsafe” in front of Tessa. It was a very odd moment and a feeling that I just don’t think I will ever get used to.

The article accompanied a Today Show segment during which Nadeau talked more about her work. And, as a reminder, she’s taking questions about food allergies this week as part of our Ask Stanford Medicine series.

Previously: Ask Stanford Med: Pediatric immunologist taking questions on children’s food allergy research and Searching for a cure for pediatric food allergies

Food allergies among children are a growing public health concern. An estimated six million children in the United States suffer from food allergies, and nearly 40 percent have experienced a severe allergic reaction as a result of consuming a food.

A recent New York Times Magazine story took a closer look at the issue and the research of Kari Nadeau, MD, PhD, a pediatric immunologist at Stanford and Lucile Packard Children’s Hospital. As my colleague previously reported, Nadeau has demonstrated that it’s possible to desensitize children to a single food allergen and is now working to identify treatments to safely address multiple food allergies at the same time.

To continue the conversation, we’ve asked Nadeau to respond to your questions about children’s food allergies and her ongoing projects at the Stanford Alliance for Food Allergy Research. Questions can be submitted to Nadeau by either sending a tweet that includes the hashtag #AskSUMed or posting your question in the comments section below. We’ll collect questions until Friday (March 15) at 5 PM Pacific Time.

When submitting questions, please abide by the following ground rules:

• Stay on topic
• Be respectful to the person answering your questions
• Be respectful to one another in submitting questions
• Do not monopolize the conversation or post the same question repeatedly
• Kindly ignore disrespectful or off topic comments
• Know that Twitter handles and/or names may be used in the responses

Nadeau will respond to a selection of the questions submitted, but not all of them, in a future entry on Scope.

Finally – and you may have already guessed this – an answer to any question submitted as part of this feature is meant to offer medical information, not medical advice. These answers are not a basis for any action or inaction, and they’re also not meant to replace the evaluation and determination of your doctor, who will address your specific medical needs and can make a diagnosis and give you the appropriate care.

Previously: Searching for a cure for pediatric food allergies, Gesundheit! Spring allergy season is underway, New hope for people with severe milk allergies and New insight into asthma-air pollution link
Photo by Steven Depolo

As I wrote about yesterday, new research in PLOS ONE suggests that sugar may play a stronger role in the origins of diabetes than anyone realized. Countries with more sugar in their food supplies have higher rates of diabetes, independent of sugar’s ties to obesity, other parts of the diet, and several economic and demographic factors, the researchers found.

Although the study focused on diabetes rates among adults aged 20 to 79, it got me thinking about children’s health. Type 2 diabetes, which accounts for 90 percent of adult cases and is tied to obesity, used to be unheard-of in kids. But over the last few decades, it has been showing up in many more children and teens at younger and younger ages. Meanwhile, reducing kids’ sugar intake is already the focus of several preventive-health efforts, such as campaigns to remove sugary drinks from schools and children’s hospitals.

To get some perspective on how the new findings apply to children, I turned to Thomas Robinson, MD, a Stanford pediatric obesity researcher who directs the Center for Healthy Weight at Lucile Packard Children’s Hospital. Though Robinson, also a professor of pediatrics at the School of Medicine, cautioned that the epidemiological, “10,000-foot view” given by this study doesn’t prove a cause-and-effect link between sugar and diabetes in individuals – “it does not prove that the amount of sugar an individual eats is related to his or her diabetes risk,” he said – he had lots to say about the new results.

What do you think the findings mean for children’s health?

Children’s behaviors and environmental exposures have an impact on adult health and disease. This study used sugar data for entire countries, not individuals. That means that both the children and the adults were living in countries where higher levels of sugars in the food supply were associated with higher rates of diabetes. The potential implications are even stronger for children than adults. Children are being exposed to that environment for a much longer time. This is particularly a problem in developing countries where their food supplies, diets and weights are changing so rapidly.

A number of us here at Stanford focus on what we can do in early life, and throughout the lifespan, to prevent diseases that have origins in childhood but only first become apparent in adulthood. One can consider our work on obesity, physical activity, sedentary behavior and nutrition in children as really the prevention of diabetes, heart disease, many cancers and other chronic diseases in adults.

What factors has prior research identified as the biggest contributors to the increase in diagnoses of type 2 diabetes in pediatric patients?

The biggest contributor identified has been increased weight, but the increasing rate of type 2 diabetes at younger and younger ages probably reflects obesity plus lots of different changes, including changes in our diets, such as more sugars and processed foods, and less physical activity. The CDC now projects that 1 in 3 U.S. children will have diabetes in their lifetimes, and it will be 1 in 2 among African-American and Latina girls. That is a pretty scary thought. That is why we focus so strongly on helping families improve their diets, increase activity levels, and reduce sedentary time. We want to prevent and control excessive weight gain and all the problems that go with it, of which diabetes is just one.

In light of the new findings, do you think that parents whose children are not obese should be concerned about how sugar consumption could raise their children’s diabetes risk?

This study doesn’t really address the question of what happens at the level of an individual child. However, it is still consistent with the advice we would give now, for both normal weight and overweight children. I definitely recommend that parents try to reduce sugars in their children’s diets. Most parents are not even aware how much sugar their children are eating. Sure, sodas and sweets are the obvious sources but sugars are also added to seemingly all processed foods, including even bread, pizza and French fries. The added sugars are just empty calories — providing extra calories and no additional nutritional benefit. So I recommend that all parents try at least to reduce the obvious sources of sugary drinks, sweets and desserts.

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The cause of some of my sleep-deprived nights.

New research out of the University of Madison-Wisconsin may fall on deaf ears – specifically parents’ ears. The study, published in American Journal of Epidemiology, has found that the amount of sleep deprivation that parents experience is actually quite minimal.

Say what?! Have the researchers seen the dark circles under my eyes or scanned the Facebook updates of my mom friends, who constantly complain about how tired and sleep-deprived they are? I guess not. But, as described on Today.com:

Researchers relied on data collected between 1989 and 2008 by the Wisconsin Sleep Cohort Study, where participants tracked how much they slept, how sleepy the were during the day and the amount they dozed. Then, to arrive at their findings, they factored in which participants had kids and how many they had.

Here’s what they found: Each child under age 2 years was associated with 13 fewer minutes of parental sleep per 24-hour period. For kids ages 2 to 5, parents had nine fewer minutes of sleep. And each child ages 6 to 18 years was associated with four fewer minutes of sleep.

“In general, parents with younger children reported shorter average sleep durations, and for parents with multiple children, each child contributed to reductions in sleep duration,” said study author Paul Peppard, assistant professor in the University of Wisconsin’s Department of Population Health Sciences.

As a mom to two little girls, the finding that more kids means more sleep loss is something I can relate to. But only 21 fewer minutes of sleep (9 minutes because of my 2.5 year old and 13 minutes because of my 11-month-old)?? I respectfully beg to differ.

Previously: Exploring the effect of sleep loss on health
Photo by Margarita Gallardo

In case you haven’t seen it, the New York Times’ Well blog quotes Stanford childhood obesity expert Thomas Robinson, MD, in a piece on how to help your kids filter the barrage of pro-junk food messages they get from food advertisements.

As the story describes, Robinson, who directs the Center for Healthy Weight at Lucile Packard Children’s Hospital, has done extensive research on children’s responses to food advertising and branding. I’m particularly fond of the study where young children tasted pairs of identical foods in different wrappers and said which they liked better. Regardless of the food tested (hamburgers, baby carrots, french fries, milk, whatever), kids said food in a McDonald’s wrapper was yummier than food in a plain wrapper.

Food advertising targeted to kids has become so pervasive – it’s not just on TV but also all over social media, Well reports – that Robinson says parents should do more than just say “no” when their children ask for junk food:

“Respond, ‘Well, why do you want that? Where did you hear about it?’ ” said Dr. Robinson. And if the answer is that the child saw it on TV or on the Internet, “Say, ‘Well, they want you to want it, they’re trying to sell you that.’ And then have a discussion.”

And what about my aspirations of nurturing young cynics? Though teaching critical viewing skills does enhance children’s awareness, Dr. Robinson told me that relying too much on notions of media literacy can actually play into the hands of the advertisers.

“That takes the responsibility away from them and puts it on the kids to be educated consumers,” he said.

If you’re wondering how to help your kids deal with the barrage of messages they get from food ads, the entire entry is well worth reading.

Previously: Health experts to Nickelodeon: Please stop promoting unhealthy food to our kids, How food advertising and parents’ influence affect children’s nutritional choices and The First Amendment and marketing junk food to kids
Photo by quinn.anya

Over on Motherlode, there’s a beautiful and heartbreaking piece on stillbirth, written by a woman who lost her daughter during her 36th week of pregnancy. Noting that stillbirth is far more common than one might think, Sarah Muthler writes:

I’ve read at least a dozen articles about SIDS, and can tick off a handful of risk factors, but until last year, I knew nothing about stillbirth. All of that talk about SIDS has saved lives. Research and awareness have helped cut the death rate in half in the past 20 years. Meanwhile, the United States stillbirth rate has barely budged in the past 15 years.

This silence around stillbirth, this fear of causing fear, leaves families blindly groping as they make the hardest decisions of their lives. If I had known anything at all about stillbirth, I could have made better decisions regarding my daughter’s death. I wish that I had been told to bring some of her clothes to the hospital so she could wear them. I wish that my husband and I had been strong enough to choose to have an autopsy even though our doctor didn’t encourage it. I wish I had known that grant money might be available to cover the several thousand dollars that the autopsy would have cost.

Muthler argues we need to find a way to talk about and educate people on the issue. “If those conversations inspire even a little more research and awareness,” she writes, “then maybe people will see that our lost babies aren’t just a horror story. They’re part of a love story, too.”

Previously: Pregnancy loss puts parents’ relationship at risk