Pediatrics

Past research has down that exercise during pregnancy benefits mom as well as baby by, among other things, helping the fetal cardiac system grow stronger and healthier. Now findings published online in PLoS One suggest that owning a dog can be a powerful motivator to get pregnant women moving.

In the first-of-its-kind study, researchers from the United States and England examined the relationship between pet ownership and physical activity levels among pregnant women. The team drew on the Avon Longitudinal Study of Parents and Children to gather data on more than 11,000 pregnant women in the United Kingdom, and they found:

Dog ownership was associated with an increased (1.5 times) likelihood of undertaking at least 3 hours per week of activity ‘enough to work up a sweat’. Dog owners showed increased levels of brisk walking, but not other types of activity, thus the specificity of the finding makes it more likely that the association is causal. In addition, the trend of increasing likelihood of dog ownership with higher levels of activity and more hours of brisk walking per week also suggests a real effect of owning a dog.

The study showed that, overall, mothers-to-be who owned dogs were approximately 50 percent more likely to stay physically active during their pregnancy. Funding for the research was provided by a grant from WALTHAM Centre for Pet Nutrition, a subsidiary of Mars Petcare.

Previously: Extreme pregnancy: A look at exercise and expectant moms, Study: Exercise may not stave off gestational diabetes, How safe is rigorous exercise during pregnancy?, Could exercise before and during early pregnancy lower risk of pre-eclampsia? and Pregnant and on the move: The importance of exercise for moms-to-be
Photo by Tomas Hellberg

My colleague Erin Digitale tells the remarkable story today of a tiny Lucile Packard Children’s Hospital heart patient named Jaya Maharaj. Weighing just 3.5 pounds, with a heart slightly bigger than a walnut, the baby received a pacemaker shortly after birth and was “smaller than any pacemaker recipient ever reported in the medical literature.”

Digitale writes in Inside Stanford Medicine:

Jaya’s surgery is remarkable not just because of her small size but because many fetuses with her condition, congenital heart block, do not survive pregnancy. Research has shown that 20 to 50 percent of patients diagnosed prenatally die in utero or in the first weeks after birth. Yet premature delivery to implant a pacemaker carries its own hazards. When Leanne Maharaj, Jaya’s mom, was first referred to Packard Children’s Hospital from her hometown of Hayward, Calif., at 28 weeks pregnant, her doctors weighed the conflicting risks.

“We knew that at any time the baby’s heart could give out,” said neonatologist Valerie Chock, MD, a member of the large, multidisciplinary team that planned Jaya’s birth and surgery. “We had to decide: At what point do we deliver to balance that risk against the risk of premature delivery?”

The baby was ultimately delivered nine weeks early and went into surgery just 15 minutes after being born. And then:

After surgery, Jaya spent six weeks in the Neonatal Intensive Care Unit. With her heart pumping properly, she grew rapidly and was able to go home on Jan. 12. Her prognosis is excellent: Her pacemaker leads must be repositioned occasionally as she grows, and she will need new pacemaker batteries every five to seven years, but otherwise she will be able to lead a normal life.

Photo by Norbert von der Groeben

Although home births account for fewer than 1 percent of births in the United States, the percentage of women choosing to deliver at home has increased notably since 2004, according to the most recent data (.pdf) from the National Center for Health Statistics.

Now new research from UC San Francisco shows that babies delivered at home may be at higher risk of complications after birth including low Apgar scores and seizures. In the study, researchers examined birth certificate data on nearly 2.3 million singleton U.S. births in 2008. Health Day reports that researchers found:

Babies born at home were more than twice as likely to have an Apgar score of under 7 as children born in a hospital or at a birthing center, and also had double the chances of having a seizure.

The Apgar score is a test used to measure a child’s skin color, pulse and overall vigor in the moments after birth.

The overall number of kids who had seizures was low — less than 1 percent at any location.

However, researchers say that some of these risks were reduced if a certified nurse midwife was present at the home birth.

Further down in the story, Mary Norton, MD, professor of obstetrics and gynecology at Stanford, comments on the findings and advises women considering a home birth to recognize that it involves certain risks. She says:

Even in a normal-health woman with a normal pregnancy, there will always be unanticipated things that can happen and unanticipated emergencies.

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This data does indicate there is a higher level of risk to the baby when delivering at home. If someone is carefully monitored, is in close proximity to the hospital and willing to go to the hospital if needed, then the risks are lower.

Previously: Tensions high in debate over safety of home births and Should midwives take on risky deliveries?
Photo by David Roseborough

In the most recent issue of Stanford Medicine, my colleague tells the story of Minnie Narth, a young woman who learned she had an aggressive form of lymphoma while she was pregnant. As detailed in the piece, there was surprise when Narth and her husband were presented with treatment options:

“Our concern was – give chemo while she’s pregnant?” says [her husband] Paul. The response he remembers from Stanford lymphoma specialist Ranjana Advani, MD, was, “Of course we can!”

The surprise is understandable, says Richard Theriault, MD, a breast oncologist at MD Anderson Cancer Center in Houston who has studied cancer and pregnancy for 20 years… “We basically tell [expectant mothers], don’t breathe, don’t do any of these things — but we’re going to give you chemo,” Theriault says. “It does sound really crazy, doesn’t it?”

The article goes on to describe the treatment decisions Narth and her doctors made, and the existing research on cancer and pregnancy – and I thought of it when I came across results of a new study on chemotherapy during pregnancy today. In a paper in The Lancet, researchers showed that children exposed to chemotherapy in the womb appear to develop normally. As WebMD reports:

Children in the study whose mothers had an average of three to four cycles of chemotherapy during [the second or third trimester of] pregnancy were subjected to a battery of tests to assess their general health, intelligence, and behavioral development.

The tests suggested that fetal exposure to chemotherapy after the first trimester is not associated with developmental and health issues.

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“The clinical message is threefold,” [Frederic Amant, MD, PhD, of Belgium's Leuven Cancer Institute] says. “First, fear of chemotherapy is generally no reason to terminate a pregnancy. Second, fear of chemotherapy is generally no reason to delay treatment when pregnant. And third, delivery should not be rushed to avoid exposing the fetus to chemotherapy.”

Previously: A family’s grace in crisis

Stanford psychology researchers are using imaging techniques to learn more about what happens in the brains of young girls at risk of depression and, as recently described here, they’re exploring a novel way to train brains away from negative situations. Ian Gotlib, PhD, discusses the work, which represents a “critical step in learning how to prevent the onset of a depressive episode,” in a Stanford Report article and the video above.

And for more on the topic, my colleague recently reported on adolescent depression and efforts to prevent it in Stanford Medicine.

Previously: Using brain-training games to stave off depression in adolescents

Since she was a toddler, my five-year-old has been utterly devoted to a mint-green stuffed hippo named, appropriately, Hippo. He/she (the toy’s gender remains undecided) has been a faithful companion to my daughter, accompanying her on vacations, snuggling up with her at naps and bedtime, and serving as a playmate when my other daughter is otherwise engaged. Hippo even benefits me by offering traffic advice in the car: “Mommy, Hippo says we should go the other way because there’s an accident straight ahead,” my daughter will say.

I’ve always assumed that having an imaginary friend – in stuffed or human form - is normal and healthy for children, but I was still heartened to read today that this is, indeed, the case. In summarizing some of the research on the benefits of imaginary companions, Huffington Post’s Lisa Belkin writes:

They serve a variety of roles in a child’s development. The NYU Child Study Center describes the creation of these companions as “the product of a creative and curious mind figuring out how to make sense of the widening world.” Marjorie Taylor, the University of Oregon professor who is one of the leading voices in the field, and who runs a website that is all about imaginary friends, says one of the many reasons for their existence is as a shield against fear. “Children can walk confidently past a scary dog when there is an invisible tiger at their side,” she writes. Others researchers have looked at how these pals help children to “try out different relationships at a critical point in their social development,” or “allow children to explore issues of control, discipline and power with the anxiety attached to interactions with real authority figures,” or just have have “fun.”

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Children are better off because of them. Among the conclusions of research into children with imaginary companions are: “those who have them more able to see things from someone else’s perspective;” “children who pretend and imagine usually are healthier emotionally as adults”; “these children are likely to be less shy and have more real life friends.”

A study in today’s new issue of Archives of Pediatrics & Adolescent Medicine takes a close look at food for sale in more than 3,800 public and private elementary schools across the U.S. between 2006 and 2010. The findings are discouraging: During a period when school menus have generated lots of attention as contributors to childhood obesity, kids’ access to sugary foods at school remained high, while healthy options remained less available.

Not surprisingly, the authors suggest that schools should take a hard look at the foods kids can buy on campus and provide more healthy options while removing unhealthy choices.

But an accompanying editorial by Packard Children’s Hospital’s Thomas Robinson, MD, a nationally-recognized childhood obesity researcher asks: “How do we know that those changes would make a dent in childhood obesity rates?”

Unless we conduct studies that compare different health policies head-to-head in rigorously designed experiments, we can’t be sure what actually works, Robinson writes. He proposes implementing randomized controlled trials that make use of existing state and national health-surveillance programs (21 states already have laws that mandate measuring children’s body mass index in school, for instance) and that assign schools to different proposed health-policy changes so that the policies’ effects can be evaluated.

If this idea sounds daunting, Robinson has prepared an answer for potential critics:

Too difficult? Too expensive? Not when compared with the unrecoverable costs of getting policies wrong. [...] Federal, state and local governments and nongovernmental organizations are already spending many hundreds of millions of dollars per year to implement policy interventions that may or may not have any impact on childhood obesity. If evaluated at all, it is usually with nonexperimental designs. It would be a terrible lost opportunity if we learned several decades from now that most of these dollars produced no health benefits.

The entire editorial is definitely worth a read.

The more ongoing stress children are exposed to the greater the odds they will struggle with their weight as adolescents, according to a study recently published in Pediatrics.
The findings (subscription required) support past research showing molecules released when a person is stressed may unlock the body’s fat cells, and additional studies suggesting that stress contributes to childhood obesity.

Futurity reports that in the latest study:

The researchers measured the height and weight of 244 9-year-olds in rural New York state and calculated their various physical and psycho-social stressors–for example, exposure to violence, living in a substandard house, or having no access to such resources as books.

They also measured the children’s ability to delay gratification by offering them a choice between waiting for a large plate of candy versus having a medium plate immediately. The researchers measured the children’s height and weight again four years later.

The study showed children who were chronically exposed to stressors such as poverty, crowded housing and family turmoil gained more weight and were significantly heavier by age 13 than they would have been otherwise. Researchers say the findings could have implications for weight management interventions and policies aimed at reducing individual stressors.

Previously: How should parents talk to their kids about weight control?, How should pediatricians talk about obesity?, Scientists take a divide-and-conquer approach to combating childhood obesity and How to combat childhood obesity? Try everything
Photo by Pink Sherbet Photography

Back in my grad-student days, stressed out by studying for midterms, I went with two friends to see a silly movie – Austin Powers in Goldmember.

The three of us, all in our early 20s, soon realized we were the oldest people in the theater by a good 10 years or so. It quickly became clear that the 12-year-olds around us had different senses of humor than we did: They adored the movie’s sight gags but missed some of the more sophisticated wordplay that had us in stitches.

The development of kids’ sense of humor is the subject of a new study published today in the Journal of Neuroscience by a research team at Stanford and Lucile Packard Children’s Hospital. The team performed the first-ever study using brain scans to see which neural networks are used when children watch humorous videos. Austin Powers was not involved in this study; they stuck with material from “America’s Funniest Home Videos.”

Although humor might at first seem trivial, it’s not all slapstick and rib-ticklers, explains the study’s senior author in a press release I wrote about the new research:

“Humor is a very important component of emotional health, maintaining relationships, developing cognitive function and perhaps even medical health,” said Allan Reiss, MD, who directs the Center for Interdisciplinary Brain Sciences Research at Stanford. […] “In particular, we think a balanced and consistent sense of humor may help children negotiate the difficult period of pre-adolescence and adolescence,” he said.

The brain networks activated in kids watching funny material are similar to those in adults, but kids’ brain networks are less sophisticated, the researchers found. The research, which was conducted in healthy 6- to 12-year-olds, lays the foundation for future studies to examine how positive states, such as humor, play into children’s overall level of resilience and their vulnerability to emotional problems like depression:

“Negative emotional states such as depression or anxiety are compelling to study, but you can’t completely understand why a child has emotional stability or instability until you look at both sides of the coin,” [Reiss] said.

Photo by wolleydog

The challenges facing pediatric surgeons was the focus of a recent segment on KQED-FM’s QUEST. During the show, Sanjeev Dutta, MD, described such challenges as “plumbing problems:”

Dutta is a pediatric surgeon at Lucile Packard Children’s Hospital, in Palo Alto, where he operates on children with these and other problems. He says often, the instruments he uses when he does these surgeries weren’t built for tiny babies. They were made for adults.

“We struggle with instruments that were never designed for the type of patient we are working on, and we adapt.”

Dutta says the issue here isn’t safety. Most of these surgeries are, by now, pretty routine. But pediatric surgeons have to improvise in ways other surgeons don’t.

The segment also highlighted how pediatric surgeons, including Dutta, are collaborating with engineers from SRI International to create tools more appropriately sized for tiny patients.

I was a pretty healthy kid growing up, something I’ve mostly attributed to my parents’ encouragement of my vegetable-eating, outdoor-playing tendencies. It wasn’t until today when I read this Reuters article that it even occurred to me that my health could influence – or predict – that of my parents.

A new study in the Journal of Pediatrics finds that kids’ health may be a good predictor of their parents’ cardiovascular health.

Charles J. Glueck, MD, of Jewish Hospital of Cincinnati led the study that measured weight, blood pressure, cholesterol and triglycerides of over 800 children at age 12, and then reassessed them, as well as their parents, 26 years later. The study found that nearly half of the now grown-up children – 47 percent – had a parent who had suffered a heart attack, stroke or needed a procedure to clear blocked arteries at some point during the duration of the study; 37 percent, a parent had developed diabetes.

For children in the study who were overweight, their parents’ likelihood of developing high blood pressure or diabetes had doubled. “Pediatric risk factors -  cholesterol, triglycerides, high blood pressure - identified families where parents were at increased risk,” Glueck told Reuters.

But what does this mean? For now, simply that childhood screenings – including one for cholesterol, which has only been recommended in recent years as part of ‘well-child’ checkups - may predict risks in both kids and parents. (And this is important, Glueck said, because some parents don’t go to the doctor’s themselves – but routinely take their children.)

Photo courtesy of parcelbrat

A growing body of research suggests that children’s friends can provide a strong calming influence on them and that these relationships have a measurable effect on stress hormones during tense times. Echoing these findings is research published in Developmental Psychology showing the presence of friends mitigates the effects of negative experiences on children.

In the small study (subscription required), researchers assigned 5th and 6th graders enrolled in Montreal schools to keep journals on their feelings and experiences over the course of four days and submit to regular saliva tests that monitored cortisol levels. Study results showed children’s feelings of self-worth and levels of cortisol, a hormone produced naturally by the adrenal gland in direct response to stress, are largely dependent on the social context of a negative experience.

Study co-author William M. Bukowski, PhD, director of the Concordia Centre for Research in Human Development, discussed the significance of the findings in a release:

Having a best friend present during an unpleasant event has an immediate impact on a child’s body and mind. If a child is alone when he or she gets in trouble with a teacher or has an argument with a classmate, we see a measurable increase in cortisol levels and decrease in feelings of self-worth.
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Our physiological and psychological reactions to negative experiences as children impacts us later in life. Excessive secretion of cortisol can lead to significant physiological changes, including immune suppression and decreased bone formation. Increased stress can really slow down a child’s development. What we learn about ourselves as children is how we form our adult identities. If we build up feelings of low self-worth during childhood, this will translate directly into how we see ourselves as adults.

Previously: Study offers insights into how friendships help children manage stress
Photo by D. Sharon Pruitt

Speaking of tweens, there’s an interesting (and sobering) article in The Atlantic today on how parents’ money-related depression may affect their middle-school-aged children. It highlights a 2011 study that found:

The more stressed the parents were about money, the more likely they (the parents) were to be depressed. Not a surprising finding. But parental depression also affected the strength of the relationships between the parents and their kids: Parents who experienced more depressive symptoms were less connected to their children — and this was true based on reports from both the parents and the kids.

But the most revealing connection was one between the intimacy of the parent-child relationships and the “pro-social behavior” of the kids. The children, between the ages of 10 and 14 when the study began, were polled on how they felt about reaching out to friends, family, and strangers. They ranked themselves on statements like “I help others even if it’s not easy for me,” “I volunteer in programs to help others in need,” and “I really enjoy doing small favors for my family.” Kids who had less-connected relationships with their parents were less likely to exhibit these pro-social behaviors than kids who enjoyed stronger relationships with their parents.

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While earlier studies have looked at the effects of the economy on kids’ psyches, they have typically considered only the development of negative behaviors, like substance abuse, mental illness, aggression, and other “problem behaviors.” The idea that the economy could, through indirect means, cause a shift or decline in kids’ positive social behaviors has not been illustrated until now.

In this video, Clifford Nass, PhD, a professor of communication at Stanford, discusses research he conducted with colleagues showing girls ages 8-12 who spend endless hours multitasking with digital devices tend to be less successful in their social and emotional development. But the good news, says Nass, is these unwanted effects might be warded off with something as simple as face-to-face conversations with other people.

A Stanford Report article published today offers more details about the study and notes that, while researchers found a correlation between some media habits and diminished social and emotional skills, a definite cause-and-effect relationship has yet to be proved.

Previously: Study shows neural “bottleneck” may limit performance while multitasking and A conversation about our evolving relationship with technology and the dangers of multitasking

A surprising potential therapy for severe, hard-to-treat malformations of the lymphatic system is now being studied at Stanford and Lucile Packard Children’s Hospital.

The malformations, called lymphangiomas, are overgrowths of the one-way lymph channels that return extra fluid from our tissues to the bloodstream. Rarely, in infants and children, these channels grow abnormally large and cause deformity or death. (The overgrowth may choke off a child’s airway or interfere with other aspects of heart and lung function.) Lymphangiomas are hard to treat, since the overgrown vessels are often too tangled into vital organs to remove surgically. And the deformity tends to grow with the child, worsening over time.

But physicians at Packard Children’s discovered, essentially by accident, that a common drug – sildenafil, a.k.a. Viagra – appears to shrink the overgrown vessels. A letter published today in the New England Journal of Medicine describes the first three cases the Stanford/Packard team treated, including MRI scans and photos that show dramatic before-and-after changes in the patients’ malformations.

“There has been no medical treatment for lymphangiomas; now all of a sudden there may be one,” Al Lane, MD, a co-author on the NEJM letter and an investigator on the lymphangioma research now underway at Packard Children’s, recently told me.

The research team has a long way to go in determining if and how sildenafil should be routinely used to treat these malformations, Lane cautioned. They’re now studying a handful of children using seed money provided by an Innovations in Patient Care grant from Spectrum Child Health, funds from SPARK, as well as medication provided by Pfizer, and they’re applying to the U.S. Food and Drug Administration’s orphan conditions program for funds to run a larger trial.

“We think this may work, but we don’t know,” Lane said. “We need to do a placebo-controlled trial.”

However, the fact that the condition is so severe and hard to treat made the team feel that it was important to get the word out about the early findings, Lane added. “We felt like, if it really works, and we have data to suggest that it does, it wasn’t fair for patients who have no other options to not at least know what we’re observing,” he said.

For more information on the current Stanford/Packard trial, visit this website.