Tuesday, August 27th, 2013
A new report from the American Academy of Pediatrics (AAP) finds that breastfeeding women can safely use many medications without harming their infants.
Experts from the AAP Committee on Drugs also noted that some doctors give moms inaccurate advice that they must quit nursing or stop taking certain medicines to keep their babies safe. From Reuters:
“Sometimes people are told that, because physicians may be worried about the risks the drug may pose … and aren’t necessarily thinking about the potential benefit of breastfeeding,” Dr. Hari Cheryl Sachs, the lead author on the report, said.
That benefit includes a lower risk of ear infections, asthma and sudden infant death syndrome, according to the U.S. Department of Health and Human Services.
Sachs said properties of the drug itself, whether it’s being used on a long- or short-term basis and the age and health of the infant all affect how safe it is to use medication while breastfeeding.
“It’s hard to make a blanket recommendation on what drugs are fine for the mother, because it’s going to depend on multiple factors,” Sachs, from the Pediatric and Maternal Health Team in the Food and Drug Administration’s Center for Drug Evaluation and Research, told Reuters Health.
If breastfeeding women have questions about specific medications, Sachs recommends that they talk with their doctors and check LactMed, a website run by the National Institutes of Health. Again from Reuters:
[LactMed] includes the most up-to-date scientific knowledge on how much of a given drug is passed to an infant during breastfeeding, its effects on babies and possible alternatives to consider.
In its report, published Monday in Pediatrics, the committee focused on a few classes of drugs, including antidepressants, narcotics and smoking cessation aids.
Limited information is available on the long-term effects of antidepressants on babies, it wrote, and because the drugs take a long time to break down, levels could build up in infants’ bodies.
“Caution is advised” for certain powerful painkillers such as codeine and hydrocodone—but others including morphine are considered safer when used at the lowest possible dose and for the shortest possible time, pediatricians said.
Nicotine replacement therapy, especially gum and lozenges, is typically considered safe to use during breastfeeding, according to the committee. However the FDA discourages the use of stop-smoking drugs such as varenicline, marketed in the U.S. as Chantix, among women who breastfeed.
The risk of exposure to any drug for babies needs to be weighed against the drug’s importance for the mother as well as the benefits of breastfeeding, researchers noted.
Image: Prescription medication via Shutterstock
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American Academy of Pediatrics, antidepressants, breast milk, breastfeeding, LactMed, medications, narcotic painkillers, National Institutes of Health, smoking cessation | Categories:
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Friday, August 23rd, 2013
A report by the National Center for Health Statistics reveals that circumcisions of newborn boys in U.S. hospitals have dropped 6 percentage points over the last 30 years, from 64.5 percent in 1979 to 58.3 percent in 2010. The sharpest declines took place in Western states, Reuters reports. The federal analysis shows that circumcision rates have risen and fallen over the years, possibly in response to changing advice from the American Academy of Pediatrics. Last year the academy revised its policy on circumcision, saying that the benefits of circumcision outweigh the risks.
The analysis didn’t include circumcisions performed outside the hospital in religious ceremonies, for example, or those performed when a boy is older.
Here are further details from USA Today:
One factor that may account for the overall decline in hospital-based circumcisions may be the decreased time babies now spend in the hospital, says pediatrician Douglas Diekema of the Treuman Katz Center for Pediatric Bioethics at Seattle Children’s Research Institute.
“Often they’re going home within 24 hours, so in some places, these procedures are increasingly being done by the pediatrician during the follow-up period in the doctor’s office or clinic as opposed to the hospital,” Diekema says.
The steep decline in the West may be related to higher rates of immigrants from countries where circumcision is less common, he says.
Recent research suggests circumcision does “help prevent certain kinds of infections,” says pediatrics group president Thomas McInerny. In particular, “there is some evidence that the cells that make up the inner surface of the foreskin may provide an optimal target for the HIV virus.” Research also shows that circumcised males have a lower risk of urinary tract infections and penile cancer, he says.
Complications associated with circumcisions are rare, and include minor bleeding, local infection and pain, says Diekema, but those factors can be easily treated.
A cost study reported last year in the Archives of Pediatrics & Adolescent Medicine said falling infant circumcision rates in the U.S. could end up costing the country billions of health care dollars when men and their female partners develop AIDS and other sexually transmitted infections and cancers that could have been prevented.
The health benefits evidence was not so strong that the AAP felt compelled to recommend routine circumcision for all newborn boys, says McInerny. “We wanted to give parents the information as we understand it from the research and let them make the decision.”
Image: Newborn boy, via Shutterstock
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Monday, August 12th, 2013
Toddlers who watch an extra hour of television daily–”extra” meaning an hour more than the two-hour maximum for children two or older recommended by the American Academy of Pediatrics–may suffer consequences when they enter kindergarten. The effects of the extra TV time, according to a new study by researchers by the University of Montreal, include diminished vocabulary and math skills, attention and concentration issues, physical prowess, and likelihood of victimization or bullying by classmates. ScienceDaily.com has more:
“This is the first time ever that a stringently controlled associational birth cohort study has looked at and found a relationship between too much toddler screen time and kindergarten risks for poor motor skills and psychosocial difficulties, like victimization by classmates,” [Professor Linda] Pagani said. “These findings suggest the need for better parental awareness and compliance with existing viewing recommendations put forth by the American Academy of Pediatrics. The AAP discourages watching television during infancy and recommends not more than two hours per day beyond age 2. It seems that every extra hour beyond that has a remarkably negative influence.”
Pagani conducted the study to discover the effect of television viewing prior to kindergarten. He said, “Much of the research on school readiness has focused on how kindergarten characteristics predict later success. Kindergarten entry characteristics predict long-term psycho-social adjustment and economic characteristics like income and academic attainment. Being innovative, my focus has been to examine what predicts kindergarten entry characteristics. Adding further originality, I also wanted to focus on neglected yet crucial aspects of school readiness such as motor skills, which predict later physical activity and reading skills, likelihood of being “picked-on,” which predict social difficulties, and skills at linked to doing what you are supposed to be doing when having been given instructions, which are in turn linked to attention systems that are regulated by the brain’s frontal lobe development.”
991 girls and 1006 boys in Quebec whose parents reported their television viewing behaviour as part of the Quebec Longitudinal Study of Child Development.
Pagani noted that the standard deviation is a commonly used statistic tool that tells us what is within a normal range compared to the average. One standard deviation from the average daily amount of television viewed by the toddlers in this sample (105 minutes) is 72 minutes. Some of the children who participated in the study were two or even three standard deviations away from the average, and their kindergarten indicators were correspondingly worse than those who were one standard deviation away.
This study only looks at the most common form of screen time, which is in the home. However, it may be an underestimate because many child care settings use television as an activity during care giving.
Image: Boys watching TV, via Shutterstock
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Wednesday, July 31st, 2013
Children who were breastfed for much of their infancy may be rewarded with higher scores on intelligence tests at ages 3 and 7, according to a new study conducted by researchers at Boston Children’s Hospital. More from Reuters:
Researchers found that for each extra month women reported breastfeeding, their children performed slightly better on those exams – though not on tests of motor skills and memory.
“Given the size of the benefit, I think this should be helpful for women who are trying to make decisions about how long to breastfeed… because there are many factors that go into that decision,” said Dr. Mandy Belfort, who led the study at Boston Children’s Hospital.
“You have to weigh that against the time that it takes, maybe the time that it takes away from work and your other family duties.”
She said the findings support recommendations from the American Academy of Pediatrics and other groups for exclusive breastfeeding up to six months of age, followed by a mix of breastfeeding and solid foods.
For their study, Belfort and her colleagues tracked 1,312 Massachusetts women who were recruited while pregnant in 1999 to 2002 and their babies.
Mothers reported if they had ever breastfed, and if so how old their child was when they stopped. The researchers then gave both women and their children standardized intelligence tests.
On language tests given at age three, children in the study scored an average of 103.7. Once the women’s intelligence and other family factors including income were taken into account, the researchers found that each extra month of breastfeeding was tied to a 0.21-point improvement on the exam.
Children who were fed only breast milk for six months scored an average of three points higher on the language test than those who were never breastfed, Belfort and her colleagues write in JAMA Pediatrics.
For intelligence tests that included reading and writing given at age seven, average scores were 112.5 and each extra month of breastfeeding was linked to a 0.35-point improvement.
Those tests take 10 to 20 minutes to complete, and 100 is considered an average score across all children.
Belfort said a parent or teacher probably wouldn’t notice a difference of a few points on a child’s intelligence test.
“I think the importance is more on the level of the whole population or society,” she told Reuters Health.
Image: Breastfeeding newborn, via Shutterstock
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Thursday, July 25th, 2013
A growing number of retail stores are offering pediatric care services, examining kids with minor health issues and saving parents a trip to the doctor’s office. A new study published in the journal JAMA Pediatrics is taking a closer look at whether these retail clinics are as effective as they are convenient. More from Time.com:
Researchers from Washington University School of Medicine, St. Louis report that even families with well-established relationships with a pediatrician take advantage of pediatric retail clinics to take care of their children’s minor health issues, even if they are staffed with non-pediatric health care personnel.
Why? The researchers surveyed 1,484 parents from 19 Midwestern pediatric practices who said that they took their kids to the clinics out of convenience; 74% of the parents said they first considered going to their pediatrician, but 37% decided on the retail clinic because it had hours that conformed better with their schedules.
In a corresponding editorial, Dr. Edward Schor of the Lucille Packard Foundation for Children’s Health in Palo Alto, California wrote that such decisions may become more commonplace: “Retail-based clinics reflect systemic changes occurring within the health care industry to which pediatric practices must adapt.” Retail clinics, which are typically run by nurse practitioners and physician assistants, are not only convenient, but cost patients about 30% to 40% less than office practices. Most of these clinics are located in retail pharmacy stores, while others are operated by hospitals or doctors’ groups.
The lower cost and increased convenience of the clinics are putting pediatricians on the defensive, and the American Academy of Pediatrics (AAP) formally opposes them as an appropriate venue for care of infants and children. AAP officials question the quality of care patients receive, stemming from the fact that children may see different practitioners at each visit.
Image: Mother and child at pharmacy, via Shutterstock
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