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Wednesday, October 31st, 2012
I just read a terrific series at Time.com about kids and DNA. One of the more intriguing questions posed was: Should you get your child’s genome sequenced?
The idea might not seem far-fetched. We hear more and more about how genes predict whether or not we will get a disease. So why not have your child’s genome screened for disease genes?
Well, there are a few key considerations to keep in mind (without even thinking about cost or ethics):
Your child’s DNA was probably already screened for major disease genes (really big ones that have severe effects on development) when they were born.
Outside of those genes (there’s probably less than 100 of them), most genetic markers are really not that informative. They give you some sense of increased risk for a disease – but a whole host of environmental factors undoubtedly contribute as well. This is especially true for “common” diseases – like most of the behavioral and emotional disorders of childhood. The fact is for common disorders a fairly high proportion of the population carries some risk genes. So without the ability to offer more specific prediction (as is the case with some of the more rare genes that convey risk for breast cancer, the gene responsible for Huntington’s Disease, etc), it’s not really clear that DNA – right now – holds that much information on your child’s future in terms of common diseases that are influenced by both genes and environment.
Of course, the most important piece of information you would hope to get is not just if your child carries a gene, but what you could do to prevent disease onset. Outside of trying to reduce obvious risk factors that you would want to reduce anyway (e.g., if your child is at risk for diabetes, you would want to monitor their diet very carefully – but you want to do that anyway), there’s not much “genome-tailored” intervention out there.
The fact is that the more we learn about DNA, the more we realize that the landscape is even more complicated than we thought. Unless you think your child is at genetic risk for a disease, and unless there is a powerful genetic screen that carries real information that can inform and direct future behavior, there’s not much practical utility right now to sequencing your child’s genome.
DNA Fingerprinting via Shutterstock.com
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breast cancer, diabetes, diseases, DNA, genome, Health, Kids Health, sequencing | Categories:
Behavior, Genetics, Health, Intervention, Must Read, Pregnancy, Red-Hot Parenting
Monday, April 9th, 2012
You may have seen or heard this morning about a new study that found links between maternal obesity and risk for autism. Here’s a breakdown on the study, the findings, and the take-home message.
What Did This Study Do? The research – published in Pediatrics – explored links between maternal metabolic conditions – specifically diabetes, hypertension, and obesity – and neurodevelopmental disorders in early childhood – particularly autism spectrum disorders (ASD) and developmental delays (DD). The sample was informative – it is a population-based sample in California that is participating in a very large investigation. That said, it’s important to keep in mind that maternal history of diabetes and hypertension during pregnancy, and obesity prior to pregnancy, were gathered retrospectively via a phone interview with the mother when kids were between 24 and 60 months of age, and also from medical records when available (which they were for over half the sample). I highlight this to emphasize that this is far from a definitive study - not that it’s a bad study, just that it is more like the first word, rather than the last word, on this topic. Do note that the available data suggested that moms could reliably report retrospectively (when they compared their responses to available medical records) – but still, this is not as informative as a prospective study. Moms were selected based on the profiles of 3 types of youth – those with ASD, those with DD, and a general population (GP) control group with neither condition. The researchers then set out to examine if there were links between the maternal metabolic conditions and these three groups of kids. So keep in mind here that this is a statistical test of association, not a more controlled experimental test that can, if you will, “prove” the associations. These kinds of studies are critical first steps to determine if future research is warranted – and not the last steps that convince the scientific community that there is a causative process at play.
What Did They Find? Keeping all of the above in mind (you have to in order to make sense of the results), the study did find a statistical link between a mother’s report of having any of the metabolic conditions and the odds of having a child diagnosed with ASD and DD. It was a moderate statistical finding (meaning statistically significant but clearly not the only factor that contributes risk for ASD and DD). To give you a sense of the data, here are the percentages of mothers with a metabolic condition, broken down by youth diagnosis:
ASD: 28.6% of the mothers
DD: 34.9% of the mothers
GP: 19.4% of the mothers
So you can see how this is a moderate statistical link – for example: 1) the majority of moms of kids with ASD did not have any metabolic conditions, 2) almost 20% of the moms of kids from the general population control group did have a metabolic condition; and 3) the finding comes from the somewhat elevated rates in the ASD and DD groups compared to the GP group. More fine-grained analyses showed that obesity in particular was associated with ASD (after controlling for other factors) – but that diabetes had an effect on a number of cognitive and social outcomes.
What’s The Take-Home Message? There are two messages from my point of view. First, from the perspective of science, the study authors devote most of their attention in their discussion of the results on the biological mechanisms by which maternal diabetes – not maternal obesity – may impact brain development in babies. This is an important avenue for future research and a key contribution from the study. Second, from the perspective of being a prospective parent, the real take-home is that management of maternal metabolic conditions is not only critically important for a number of health outcomes, but also for promoting brain development in the early years of life. Rather than focusing on metabolic conditions as “causes” of disorders, it’s probably better advised to consider them as modifiable influences on development. Maternal obesity is important in this sense because it is one of many factors associated with diabetes – though keep in mind that gestational diabetes can of course occur without obesity. Diabetes – whether in place prior to pregnancy or occurring during pregnancy – is important because it might have biological influences on brain development. So this study just reinforces the bigger message that I hope everyone is aware of – that pregnant women should get vigilant care for potential or existing metabolic conditions during pregnancy, especially diabetes. It’s critical for the well-being of both mom and baby.
Image of word “diabetes” via Shutterstock.com
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ASD, autism, autism spectrum disorder, diabetes, gestational diabetes, Health, maternal obesity, obesity, Pregnancy | Categories:
Behavior, Health, Must Read, Parenting, Pregnancy, Red-Hot Parenting
Saturday, December 31st, 2011
There are lots of transitions in kids sleep patterns and habits, including big ones that happen during the toddler years. That said, there are also critical changes that occur during childhood and middle childhood (I’m focusing here on 5 – 11 years of age). Most importantly, this is a developmental period where the consequences of sleep deprivation can be especially harmful. So the 2nd installment of my three-part series on sleep challenges focuses on childhood and middle childhood.
What are the expectations? The biggest issue is that kids are in school for a good part of the year and as such are expected to have consistent sleep schedules that provide sufficient sleep to handle their cognitive, social, and emotional load. Kids between 5 and 11 years old should be getting between 10 and 11 hours of solid sleep every night, with consistent bedtimes and wake-up times. They also should not be tired during the day.
What are the challenges? Let’s start with the biggest challenge – understanding how much sleep your child actually needs and the negative consequences of not getting it. It’s troubling that study after study reports most kids get less sleep than they need – typically 1 hour less per night than is suggested. Add to this the observation from new studies that many kids get inconsistent sleep that can vary greatly from night to night. Such irregular sleep patterns have been shown to lead to substantial metabolic changes that promote risk for obesity and diabetes. And recent scientific reports – such as one that I flagged as one of the most influential studies of 2011 – have shown that sleep deprivation can have accumulating negative effects on cognitive development in childhood during key ages for learning (e.g., from 2nd grade through 4th grade). The culprits that undermine sleep can be many, including a lack of careful supervision of kids’ sleep habits, TV and electronics being available at bedtime (especially in the bedroom), increasing activities outside of school, and increasing time demands after school (such as homework).
How should you handle these challenges? We don’t typically think that sleep needs to be monitored in bigger kids like it does when we are dealing with babies or toddlers. But this isn’t true – in fact kids’ increasing independence screams out for parental monitoring given the sleep epidemic these days and the very real and serious consequences of sleep deprivation. A good start is to become familiar with the signs of sleep deprivation in children, which include the following
- being very hard to wake-up on a consistent basis
- sometimes falling asleep much earlier than usual
- falling asleep frequently in the car
- hearing from observers (such as teachers) that they seem tired, are yawning a lot, etc
If your child is showing some of these behaviors, it may be time to monitor their sleep habits more closely. Work backwards from when they need to get up and the amount of sleep they require to set a firm bedtime. Limit use of electronics before bedtime (maybe follow at a minimum a 30-minute rule – all technology gets shut down 30 minutes before bedtime). Promote reading as a good form of winding down. And try to be vigilant to make sure your child gets consistent sleep during the week – or put another way, try to avoid irregular sleep habits.
Image of sleeping child via Shutterstock.com
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cognitive development, diabetes, Health, kids' sleep, kids' sleep problems, learning issues, obesity, sleep, sleep deprivation | Categories:
Behavior, Health, Parenting, Red-Hot Parenting