Other than a prolonged tantrum perhaps, nothing upsets the normal give-and-take between parent and child more than a child who is running a fever. Mild temperature elevations are usually a benign, physiologic response to a mild viral infection. Yet many well-meaning parents give their kids medicine for no other reason than to keep the temperature down. As if treating the fever was the same thing as treating the virus.

Now, a task force from the American Academy of Pediatrics has advised physicians and parents that a fever, in and of itself, should not be a cause for concern, and that parents should not bother  treating low-grade fevers in kids unless they are demonstrably uncomfortable because of the fever.

In short, parents should try to keep kids comfortable rather than reducing their temperature to a pre-determined number.
 
The viruses that cause most fevers typically last just a few days and cause no harm. And although febrile seizures do occur, the group says anti-fever medicine don’t necessarily prevent them.

“There is no evidence that fever itself worsens the course of an illness or that it causes long-term neurologic complications,” the report stated. In fact, fever is one mechanism by which the body fights viral infections. It slows growth and reproduction of the germs that typically cause fever and enhances neutrophil and T-lymphocyte production, for example.

According to the report, nearly half of all parents believe (incorrectly) that a temperature less than 100.4 degrees constitutes a fever, and nearly 25% would give antipyretics to their children for temperatures less than 100. And nearly 85% of parents would awaken a sleeping child if it was time to administer a dose of anti-fever medicine.

That’s unwise. “If they’re sleeping, let them sleep,” Henry Farrar, an emergency room pediatrician and report co-author said in an interview. (more…)

Millions of people watch YouTube videos depicting teens injuring and cutting themselves, according to a new study. The authors conclude that the videos may serve to legitimize the behaviors as acceptable, even normal.

To assess the scope and accessibility of self-injury videos on the Internet, Stephen Lewis of the University of Guelph, and colleagues searched YouTube for keywords like “self-harm,” and “self-injury.”

They found that the top 100 most frequently viewed videos were watched more than 2.3 million times. Ninety-five percent of the viewers were female. Their average age was 25, although Lewis’ group suspects their actual average age was lower, since some YouTube viewers provide restricted content only to older viewers.

Typically, the videos contained graphic images of cutting, embedding and burning. Many of the videos contained statements of despair or images of sad or crying people. About 42% of the videos neither encouraged nor discouraged self-injury. An additional 26% denounced the behavior, while 23% gave a mixed message and 7% actually encouraged people to perform the depicted behavior.

Most of the videos contained no warnings or viewing restrictions. Viewers tended to rate these videos highly (an average score of 4.61 out of 5). Self-harm videos were identified as “favorites” over 12,000 times. (more…)

Energy drinks represent the fastest growing segment of beverage sales in the US, with revenues predicted to surpass $9 billion this year. Children, teens and young adults consume at least half of all energy drinks.

Is there a problem with this? Perhaps so, according to the results of a new study. Many energy drinks contain high levels of unregulated ingredients and therefore could pose a health risk to the younger folks who consume them so avidly.

To review the effects and adverse consequences of energy drink consumption among children, adolescents, and young adults, Sara Seifert, of the University of Miami, and colleagues searched PubMed and Google for an assortment of terms including “energy drink,” “sports drink,” “guarana,” “caffeine,” “taurine,” “diabetes,” and “poison control center.” They reviewed the articles they found as well as manufacturer Web sites for product information.

The review suggested that 30-50% of young people consume energy drinks in the US, although there is considerable variation in the types of drinks consumed and the frequency with which they are consumed.

The adverse consequences of energy drink consumption, as documented by the scientists’ review, can be divided into 3 categories: caffeine overdoses, organ system dysfunction and interactions with drugs. Let’s review these briefly:

Caffeine Overdoses
Nearly half of the 5,448 caffeine overdoses in 2007 involved people who were 19 years old or less, the scientists reported. They weren’t able to determine which cases were caused by the consumption of energy drinks, but suggested that it is substantial.

Energy drinks typically contain between 70-80 mg of caffeine per 8-oz. serving, or about 3 times as much as is found in most cola drinks. Since energy drinks are classified as dietary supplements rather than food, producers aren’t required to specify the caffeine content on the label, or the amounts of other ingredients which could add more caffeine. (more…)

School-aged kids that get more sleep—even if it’s “catch-up” sleep on weekends—are less likely to be obese and have metabolic abnormalities, according to the results of a new study.

To reach these conclusions, David Gozal of the University of Chicago, and colleagues monitored sleep patterns for one week using wrist actigraphs in 308 children who were between 4 and 10 years old. In a subset of these kids, the researchers also obtained fasting blood levels of glucose, lipids, insulin, and C-reactive protein.
 
Overall, the kids averaged about 8 hours of sack-time per night, far less than the 9-10 hours pediatricians recommend for this age group.

More importantly, the subset of the kids who got the least amount of sleep and also the most night-to-night variability in sleep duration were 4.4 times more likely to be obese than those who got the most sleep. Kids in the former category were more also more likely to have abnormal blood levels of insulin, low-density lipoprotein, and C-reactive protein.
 
Kids who “caught-up” on sleep on weekends did better than those who didn’t, according to Gozal’s group. Although they were more than twice as likely to be obese as those who achieved high levels of sleep without the need for “catch-up,” they were still far less likely to be obese.

“In other words, the longer and more-stable sleep duration is, the less likely a child is to manifest (obesity and) metabolic dysfunction,” the researchers wrote.

Of course, the correlations demonstrated in this study don’t prove causal links between sleep duration and weight or metabolism function, nor do they prove that sleep-deprived kids could benefit by getting more shut-eye. Even so, the scientists mentioned that sleep deprivation could be linked to obesity via scientifically proven alterations in the physiology of appetite-controlling substances like ghrelin and leptin. (more…)

Most people accept that pets can make the home a more inviting, relaxed place to be. Owners enjoy uncomplicated relationships with their pets, and unlike most humans, pets provide unconditional love and support. But can a pet actually improve your health?

A pioneering, 1980 study by Erika Friedmann, then of Brooklyn College, suggested this was indeed the case. Friedman and colleagues showed that people with “animal companions” had significantly improved one-year survival following discharge from a coronary care unit. Moreover, the survival benefit was not attributable to increased exercise associated with, say, walking a dog. Instead, it appeared to be driven by improved psychological functioning and reduced levels of stress.

Several recent studies support Friedmann’s observation. For example, a 2002 study by Karen Allen’s group at the University of Buffalo showed that pet owners had lower resting heart rates and blood pressure levels, and smaller rises from baseline levels when they were exposed to stress-producing situations. Furthermore, the stress-related rises in these parameters were blunted to the greatest extent when pets were present during the stressful situations.

Other studies have shown that pets seem to reduce annual visits to the doctor, and are associated with a lower incidence of obesity.  In addition, preliminary studies suggest a link between pet ownership and higher circulating levels of oxytocin, a hormone that directly counteracts the effects of stress-related hormones. These findings, if validated, would help provide a physiological explanation for the proposed link.

However, many studies have reached the opposite conclusion. For example, Australian scientists recently reported that pet ownership, particularly cat ownership, was associated with increased cardiac morbidity and mortality in the year following hospital admission for acute coronary syndrome. Another study suggests that cat ownership significantly increases the risk for developing eczema in kids who are allergic to cats. Beyond this of course, is the obvious increase in the risk for sustaining animal bites, and the rare but real risk that the pet owners will contract diseases like toxoplasmosis and cat scratch fever from their pets. (more…)

Just about everybody agrees that kids should eat breakfast every day. Breakfast improves their overall nutrition and their performance in school, among other things. But how helpful can breakfast really be if it consists of cereal deluged in sugar?

“Not very” is the answer.

Thankfully, a new study by Jennifer Harris and colleagues at Yale suggests that kids are perfectly willing to consume low-sugar cereals instead, particularly if they can add a pinch of table sugar or fresh fruit to the mix.

To evaluate kids’ willingness to eat low-sugar cereals, Harris’ team randomized 91 kids between the ages of 5 and 12 to two groups. Kids in the first group were offered low-sugar cereals like Cheerios, Corn Flakes and Rice Krispies which contain 1 to 4 grams of sugar per serving. Kids in the other group chose between Cocoa Pebbles, Frosted Flakes and Fruit Loops, which contain about 12 grams of sugar per serving.

Kids in both groups were also offered OJ, 1% milk, pre-cut sections of bananas and strawberries and sugar packets. The kids served themselves and then completed a questionnaire about their breakfast.

Harris’ team found that kids randomized to the low-sugar cereals consumed about half as much refined sugar as those in the high-sugar group (12.5 g versus 24.4 g). They were also more than 6 times as likely to add fresh fruit (54% versus 8%). As well, they were equally likely to “like” or “love” their breakfast. The amount of milk, orange juice and total calories consumed did not differ between the groups.

The authors concluded that “compared with serving low-sugar cereals, high-sugar cereals increase children’s total sugar consumption and reduce the overall nutritional quality of their breakfast. Children will consume low-sugar cereals when offered, and they provide a superior breakfast option.”

 The authors added that their results probably underestimat the overall impact of giving kids low-sugar cereals for breakfast. “Children’s taste preferences develop over time through continued experiences with different foods,” they wrote. “If kids are given highly sweetened cereals regularly, they are likely to learn to prefer sweetened foods in general.”

The write-up appears in Pediatrics. Cereal marketers and moms, take note!

Teenagers with otherwise healthy lifestyles consume large amounts of sports drinks and high-calorie fruit drinks, probably because they believe the products are “healthy,” according to scientists from the University of Texas.

To reach these conclusions, Nalini Ranjit and colleagues surveyed 15,000 students attending grades 8-11 during academic year 2004-2005. The survey asked about dietary and exercise habits, as well as time spent watching TV, playing video games and using computers.

The scientists found that teens who preferred flavored and sports beverages (FSBs) over soda tended to exercise harder and more frequently, and to consume truly healthy foods more often.

“The most likely explanation for these findings is that FSBs have been successfully marketed as beverages consistent with a healthy lifestyle, to set them apart from sodas,” Ranjit’s team concluded in their write-up, which appears in Pediatrics.

FSBs contain miniscule amounts of fruit juice and about the same amount of sugar as carbonated soda.

The link between FSB intake and a healthy diet turned out to be stronger in girls. Girls who consumed 3 or more FSBs per day were more likely to consume more milk, fruit and vegetables.

The link between FDB intake and exercise was more apparent in boys. Boys who consumed 3 or more FSBs per day engaged in more vigorous exercise and participated more regularly in gym class and organized sports.

Commenting on the team’s findings for MedPage Today, Vanderbilt University sports medicine expert Alex Diamond said that, “marketing has a great deal to do with the perception that sports drinks are generally healthy. They have a role when it comes to prolonged activity or exercise, but on a regular basis, it’s not something kids should be drinking just to get hydration.”

Camel Orbs, a flavored Tic Tac-like tobacco-containing pellet introduced last year by R.J. Reynolds,  poses a threat to children, according to a new study published in Pediatrics.

The smokeless tobacco product is supposed to be used by smokers when they can’t light up. It contains 1 mg of nicotine, about half that received by smoking one cigarette.

This amount can cause nausea and vomiting in a small child (a lethal dose of nicotine for an infant is about 1.0 mg/kg body weight). The problem is made worse by the fact that the Orb contains a highly bio-available form of nicotine.

To reach these conclusions, Hillel Alpert and colleagues from the Harvard School of Public Health  reviewed 13,705 tobacco product ingestion cases by children under 6 years of age that were reported to 61 regional poison control centers between 2006 and 2008.

The scientists counted 13,705 cases of tobacco product ingestion, more than 70% of which involved infants less than 1 year of age. Orbs came in second only to cigarettes themselves as the substance ingested by the kids. There was one death.

In an accompanying editorial, Marisa Cruz and Lawrence Deyton of the FDA Center for Tobacco Products said their agency has requested information from RJR and will be seeking “research around the impact of marketing for dissolvable tobacco products on young people, how adolescents and young adults perceive such products, and whether dissolvable tobacco products may lead to initiation or persistence of tobacco use in this population.”

An RJR spokesperson said the company hadn’t known of any pediatric adverse events caused by Orbs ingestion before the article was published. He added that Orbs taste like tobacco despite the candy-like flavorings and that the packaging meets government standards for child resistance.

In a recent survey, only 67% of US citizens said they believed the H1N1 vaccine is safe, and only 22% claimed they were “very” confident it is safe. Among the respondents who said they were not confident in its safety, only 6% planned to take the spike.

One concern about the injectible H1N1 vaccine is that it contains thimerosol, a mercury-based preservative that is also found in the MMR vaccine. Many believe thimerosol causes autism, although there is no scientific evidence to support this belief.

With H1N1 spreading rapidly and scary (though still relatively rare) reports of fatal complications in previously healthy individuals stricken with the infection, officials know it is critical to prove, if possible, that the vaccine is safe.

A report in Pediatrics has provided some heartening news in this regard, at least as it relates to thimerosol.

In the report, Michael Pichichero and colleagues from the Rochester General Research Institute measured mercury levels in the blood of the smallest children — low birth weight neonates and prematurely born babies after they received a thimerosol-containing vaccine.

They found blood mercury levels in these patients to be exceedingly low.

“We found that blood mercury levels before vaccination were often detectable…at a level similar to many children after the vaccination,” Pichichero said in a press release. After the babies were given vaccines containing thimerosol, “their blood levels of mercury did rise to very low levels and then fell rapidly to baseline levels by day ten after the vaccination.”

Thimerosol has been largely removed from vaccines in the US since 2001, so the study of 72 newborn infants was conducted at a hospital in Argentina. Argentina and many other countries purchase vaccines through sources supported by the WHO, which has rejected the assertion that thimerosol is unsafe in vaccines.

“The H1N1 vaccine is safe and should be given to those at risk as recommended by the US Centers for Disease Control,” concluded Pichichero.

A recent study in Pediatrics suggests that about 1% of US children have autism or a related disorder. That’s nearly 50% higher than previous estimates.

To determine the prevalence of the condition among US children aged 3 to 17 years, Michael Kogan and colleagues at the Health Resources and Services Administration and the CDC queried data from the 2007 National Survey of Children’s Health, which involved outbound calls to more than 78,000 parents.

In the Survey, parents were asked whether a health care provider had ever told them their child had autism, Asperger’s disorder, or pervasive developmental disorder, which are the 3 behavioral conditions that comprise Autism spectrum disorder, or ASD.

Parents who said yes were then asked whether their child had the condition at the time of the call.

The scientists found that 673,000 children had ASD, which equates to a prevalence just above 1%. The odds of having ASD were 4 times higher in boys than in girls. Non-Hispanic black and multiracial children had lower odds of ASD than white children.

Interestingly, parents reported that 40% of all children who were once labeled as having ASD did not currently have it, a finding that suggests over-diagnosis of the condition since there is no known cure.

The reported 1% prevalence is higher than that cited by the previous gold-standard study on the subject, which was published in 2003. It said the prevalence was 1 in 150.

But many urged caution about the apparent change in prevalence. “We don’t know whether the change over time is a result of the change in the actual condition or due to the fact that the condition is being recognized differently,” the CDC’s Ileana Arias told CNN.

The study raises “a lot of questions about how we are preparing in terms of housing, employment, social support — all the issues that many of these people are going to need,” added Tom Insel, who directs the National Institute of Mental Health.