No Cognitive Deterioration Found After Two Years of Youth Football Interview with:

Sean C. Rose, MD Pediatric sports neurologist and co-director of the Complex Concussion Clinic Nationwide Children’s Hospital 

Dr. Rose

Sean C. Rose, MD
Pediatric sports neurologist and co-director of the
Complex Concussion Clinic
Nationwide Children’s Hospital What is the background for this study? What are the main findings? 

Response: Very limited data has been collected in children while they are playing contact sports to study the relationship between repetitive head impacts and neurocognitive outcomes.  We previously published a 1-year analysis of youth tackle football players and found no association between the number or severity of head impacts and performance on neurocognitive testing before to after the football season.  We are now reporting the results from the 2nd year of our study, tracking children through two seasons of football participation.

We measured head impacts using helmet sensors during the 2016 and 2017 football seasons.  In the total group of 166 players age 9-18, one outcome measure (processing speed), out of the 23 outcome measures studied, declined over time.  However, several other measures that also assessed processing speed did not decline.  Neither the total burden of head impacts nor the intensity of individual impacts were associated with changes in testing performance over the course of the two seasons.

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Type 1 Diabetes in Children Alters Brain Growth and Function Interview with:

Nelly Mauras, MD Chief, Division of Pediatric Endocrinology, Nemours Children’s Health System Professor of Pediatrics Mayo College of Medicine

Dr. Mauras

Nelly Mauras, MD
Chief, Division of Pediatric Endocrinology,
Nemours Children’s Health System
Professor of Pediatrics
Mayo College of Medicine What is the background for this study?  

Response: Keeping blood sugars close to normal in young children with diabetes is often limited by parental fears of the risks of low blood sugars and impaired cognitive development. Dr. Nelly Mauras, at the Nemours Children’s Health System in Jacksonville FL, along with Dr. Allan Reiss at Stanford University are co-principal investigators of the Diabetes Research in Children Network, a 5-center consortium performing studies in children with diabetes, also including the University of Iowa, Washington University St Louis and Yale University.

The investigators recruited 144 children with type 1 diabetes who were 4-7 years old and performed brain imaging (MRIs), did special cognitive tests, and monitored blood sugars using continuous glucose monitors. These studies were repeated after 18 months, approximately 54 months and 74 months, to examine changes in the brain and compare the results with those of 70 children the same age who do not have diabetes.

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Childhood Abuse More Likely With Male Caregiver, especially Mother’s Boyfriend Interview with:

Amanda Fingarson, DO  Attending Physician, Child Abuse Pediatrics  Ann and Robert H. Lurie Children’s Hospital of Chicago  Assistant Professor of Pediatrics  Feinberg Northwestern School of Medicine      

Dr. Fingarson

Amanda Fingarson, DO
Attending Physician, Child Abuse Pediatrics
Ann and Robert H. Lurie Children’s Hospital of Chicago
Assistant Professor of Pediatrics
Feinberg Northwestern School of Medicine  What is the background for this study?  What are the main findings?

Response: Child physical abuse is a substantial pediatric public health issue, with significant morbidity and mortality. Studies have found that men, particularly children’s fathers and mothers’ boyfriends are common perpetrators of physical abuse. There is still a lack of knowledge, however, about the specific caregiver features that increase a child’s risk for physical abuse.

Our study design was unique, in that it was a multi-center study that compared young children with abusive and accidental injuries.

Our primary finding was that abuse was much more likely when a male caregiver was present, and the resulting injuries were more likely to be severe or fatal. The presence of the mother’s boyfriend was the riskiest scenario, with the highest likelihood of abuse. Similarly, we found that caregiver relationships of less than 1 year increased the odds of abuse. Overall, the likelihood of abuse with female caregivers was much lower, with the exception of female babysitters.  A final important finding of our study was that caregiving arrangements that were different than usual at the time of injury were at increased risk of abuse, suggesting that a stable and consistent caregiver is also important.  Continue reading

Sexting Linked to Increased Sexual Activity and Substance Abuse Among Teenagers Interview with:
texting, sextingCamille Mori, B.A. (hons)
M.Sc. candidate
Clinical Psychology Program
Determinants of Child Development Lab
University of Calgary What is the background for this study?

Response: Sexting, which is the sharing of sexual messages, images, or videos over technological devices, has recently become a cause for concern among parents, teachers, and policy makers. However, the research on sexting among youth is still in early stages, and evidence of the risks associated with sexting is inconsistent. One way to resolve discrepancies in the field is to conduct a meta-analysis, which statistically summarizes existing research. We conducted a meta-analysis in order to examine the association between sexting and sexual activity (having sex, multiple sexual partners, and lack of contraception use). The associations between sexting and mental health related variables, including delinquent behaviour, substance use, and depression/anxiety were also examined.

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Measles Vaccine in Early Childhood Associated with Long Term Health and Cognitive Benefits Interview with:

Arindam Nandi  PhD Center for Disease Dynamics, Economics & Policy

Dr. Nandi

Arindam Nandi  PhD
Center for Disease Dynamics, Economics & Policy What is the background for this study?  

Response: The motivation for this study comes from a small but growing body of evidence on the potential long-term benefits of vaccines. The recent resurgence of measles outbreaks in several countries which had previously eliminated the virus makes our study additionally relevant. There have been over 1,000 measles cases reported across 28 states in the US so far in 2019, which is the largest number of cases the country has seen in almost 3 decades. Similarly high number of cases have been reported in several European countries in recent years. This study reiterates the importance of vaccination and proves the long-term benefits of the measles vaccine in low- and middle-income countries, which account for a large proportion of global measles cases.

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Decrease in Obesity Among Young US Children Enrolled in Special Supplemental Nutrition Program 2010-2016 Interview with:

Liping Pan, MD, MPH Epidemiologist Division of Nutrition, Physical Activity, and Obesity National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention

Dr. Pan

Liping Pan, MD, MPH
Division of Nutrition, Physical Activity, and Obesity
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention What is the background for this study?

Response: Children with severe obesity face significant health and social challenges. Children with obesity are at higher risk for having other chronic health conditions and diseases, such as asthma, sleep apnea, bone and joint problems, and type 2 diabetes. They also have more risk factors for heart disease such as high blood pressure, impaired glucose tolerance, and high cholesterol than their healthyweight peers. Children with obesity can be bullied and teased more than their healthyweight peers. They are also more likely to suffer from social isolation, depression, and lower self-esteem. Children with obesity are also more likely to have obesity as adults. This can lead to lifelong physical and mental health problems. Adult obesity is associated with a higher risk of type 2 diabetes, heart disease, and many types of cancers. 

Childhood obesity is more common among children from lower-income families, as many lack access to healthy, affordable foods and beverages and opportunities for low-cost physical activity.

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Keep Your Up Cosmetics and Out of Sight of of Kids Interview with:

Rebecca McAdams, MA, MPH CHES Senior research associate Center for Injury Research and Policy Nationwide Children’s Hospital Columbus, OH

Rebecca McAdams

Rebecca McAdams, MA, MPH CHES
Senior research associate
Center for Injury Research and Policy
Nationwide Children’s Hospital
Columbus, OH What is the background for this study?  

Response: Cosmetic or personal care products are found in nearly every US home and include items such as nail, hair and skin care products. Many of us use these products daily. Although a cosmetic product may not be harmful when used according to the directions, it is important for parents and caregivers to know that a young child could be seriously injured by these products.

This study found that 64,686 children younger than five years of age were treated in U.S. emergency departments for injuries related to personal care products from 2002 through 2016 – that’s an average of about one child every two hours. What are the main findings?

Response: The study found that most injuries from these products occurred when a child swallowed the product (75.7%) or the product made contact with a child’s skin or eyes (19.3%). These ingestions and exposures most often led to poisonings (86.2%) or chemical burns (13.8%).

The study found that the top products that led to injuries were nail care products (28.3%), hair care products (27.0%), skin care products (25.0%), and fragrance products (12.7%). When we looked at specific cosmetic products, nail polish remover was the single product which most frequently caused injuries (17.3%). For all products, children younger than 2 years of age were most commonly injured (59.3%), and they were more than twice as likely to be injured by a cosmetic product compared to children 2-4 years of age. 

As the first comprehensive examination of cosmetic-related injuries in children younger than 5 years of age using NEISS data, these results indicate a steady and persistent number of cosmetic-related injuries for children. Children younger than 2 years demonstrated different patterns and injury rates, relative to children aged 2 to 4 years. These findings demonstrate the need for increased efforts and prevention messaging to reduce the burden of cosmetic injuries. Particularly, prevention efforts need to be age-specific to couple developmental milestones with corresponding cosmetic product exposures. What should readers take away from your report?

Response: It’s important for parents and caregivers with young children in the home to store all personal care products safely – up, away, and out of sight – in a locked cabinet is best. There are many products on the market to assist with safe storage. A variety of cabinet and drawer locks and latches are on the market which enable most spaces to be made more secure. These products can typically be purchased at grocery stores, mass retailers, drug stores, home improvement stores, hardware stores, and online.

It’s best to store personal care products up (in a cabinet children cannot reach), away (not just sitting on a shelf), and out of sight (in an opaque container or behind an opaque door or drawer). Remember that using child safety products like locks and latches will make storage safer and child-resistant, but no product will make your home completely child-proof.

Parents and child caregivers can help children stay safer by following these tips:

  • Up, away and out of sight. Store all personal care products safely: up, away and out of sight – in a cabinet that can be locked or latched is best. Never leave personal care products out unattended and put them away immediately after use.
  • Store safely now. It is never too soon to start practicing safe storage. Almost 60% of the injuries in this study were to children younger than 2 years of age.
  • Original containers. Keep all personal care products in their original containers.
  • Know how to get help. Save the national Poison Help Line (1-800-222-1222) in your cell phone and post it near your home phones. What recommendations do you have for future research as a result of this work?

Response: The persistence of cosmetic-related morbidity highlights the need to apply injury prevention strategies to this domain of consumer products. New emphasis needs to be placed on the safe storage recommendations put forward by the American Academy of Pediatrics on bathroom safety, and considerations need to be taken to store these items safely in the bedroom and common areas as well. Of particular relevance is the notion that cosmetic products need to be stored in the same manner as medications: in locked cabinets that are high and out of reach of young hands. Furthermore, not to be underestimated is the role of health care providers in advocating for safe storage of these common products through education at well-child appointments.

I have no financial relationships or potential conflicts of interest relevant to this article to disclose.


Cosmetic-Related Injuries Treated in US Emergency Departments: 2002 to 2016

Jordan VajdaMA, MDivRebecca J. McAdamsMA, MPHKristin J. RobertsMS, MPHMotao ZhuMD, MS, PhDLara B. McKenziePhD, MA |
First Published June 16, 2019






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More Scooters Means More Head and Face Injuries Interview with:

Amishav Bresler MD Department of Otolaryngology - Head and Neck Surgery Rutgers - New Jersey Medical School

Dr. Bresler

Amishav Bresler MD
Department of Otolaryngology – Head and Neck Surgery
Rutgers – New Jersey Medical School What is the background for this study?

Response: This study was inspired by a personal experience with the rental scooters.

The most recent American Academy of Otolaryngology-Head and Neck Surgery annual conference was in Atlanta this year. At the time of the conference, the scooter rental industry had recently entered the region. A friend of mine, another ENT resident, was encouraging others to use these scooters for transportation for both the novelty and convenience. However, he didn’t even have a helmet!

Here was a well-educated doctor who takes call for craniofacial injuries, who was about to get on a scooter without a helmet. This experience made me wonder if scooters were dangerous scooters and their overall impact on public health.

In terms of the backgroud, the personal transportation industry is undergoing a revolution. The search for efficient and environmentally-friendly urban transportation ignited an ongoing debate in the United States regarding the role of motorized scooters. Although known to be a popular method of transportation in Europe and Asia, motorized scooters have only recently begun to make inroads in the United States. The gradual rise in popularity has been attributed to their convenience, affordability, and status as a “green” alternative to vehicles with combustion engines. These advantages combined with the fact electric scooters enable users to travel longer distances than conventional scooters present an attractive method of transportation to school, work, and leisure.

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Children with High Risk AML: Intensification of Induction II Chemotherapy and Liberalization of Stem Cell Donor Source does not Improve Outcomes Interview with:
Joseph Germino, M.D., PhD
Vice President US Medical Affairs Oncology
Bayer Healthcare Pharmaceuticals
Whippany, N.J. 07981 What is the background for this study?

Response: Sorafenib (Nexavar®) is an oral anticancer therapy approved in more than 100 countries worldwide. It is approved for the treatment of patients with advanced hepatocellular carcinoma (HCC); advanced renal cell carcinoma (RCC) who have failed prior interferon-alpha or interleukin-2 based therapy or are considered unsuitable for such therapy; progressive, locally advanced or metastatic differentiated thyroid carcinoma (papillary/follicular/Hürthle cell), that is refractory to radioactive iodine (RAI).

The AAML 1031 is a recently completed Phase III clinical trial evaluating the use of bortezomib and sorafenib in patients 30 years or younger with newly diagnosed acute myeloid leukemia (AML).

At the 2019 ASCO Annual meeting, results of a report from the AAML1031 trial, which assessed whether intensification of Induction II chemotherapy (ADE or AraC/ Mitoxantrone) and liberalized stem cell transplant (SCT) donor source criteria improved clinical outcomes in patients with residual AML.  Continue reading

Canadian ERs Use Less Pediatric Diagnostic Imaging Than US Interview with:

Eyal Cohen, MD, M.Sc, FRCP(C)Professor, PediatricsUniversity of TorontoCo-Founder, Complex Care ProgramThe Hospital for Sick Children

Dr. Cohen

Eyal Cohen, MD, M.Sc, FRCP(C)
Professor, Pediatrics
University of Toronto
Co-Founder, Complex Care Program
The Hospital for Sick Children What is the background for this study?

Response: Minimizing care that provides little benefit to patients has become an important focus to decrease health care costs and improve the quality of care delivery.  Diagnostic imaging in children is a common focus for campaigns designed to reduce overuse both in Canada and the US. There are some suggestions that there may be more overuse of care in the United States than Canada, but there has been little study in children.

We compared the use of low-value diagnostic imaging rates from four pediatric emergency departments in Ontario to 26 in the United States from 2006 to 2016.  We defined low-value imaging as situations where children are discharged from an emergency department with a diagnosis for which routine use of diagnostic imaging may not be necessary, like asthma or constipation.  Continue reading

Larotrectinib (VITRAKVI® ): Efficacy and Safety in Pediatric TRK Fusion Cancer Patients Interview with:

Douglas S. Hawkins, M.D. Hematology/Oncology Division Chief and Professor Pediatrics at Seattle Children's Hospital University of Washington School of Medicine

Dr. Hawkins

Douglas S. Hawkins, M.D.
Hematology/Oncology Division Chief and Professor
Pediatrics at Seattle Children’s Hospital
University of Washington School of Medicine What is the background for this study?

Response: TRK fusion cancer is caused by a rare genomic alteration called a neurotrophic receptor tyrosine kinase (NTRK) gene fusion.

Larotrectinib is a central nervous system (CNS) active, oral and highly selective TRK inhibitor used for the treatment of adult and pediatric patients with solid tumors that have a rare genomic alteration called an NTRK gene fusion. Larotrectinib was approved at the end of 2018 in the U.S. under the brand name VITRAKVI®, with European and worldwide regulatory submissions underway.

At ASCO 2019, we will be presenting results from a new analysis specifically looking at the efficacy and safety of larotrectinib in pediatric patients (n=34) included in the expanded dataset from both adults and children across 24 tumor types, which was presented first at the European Society for Medical Oncology (ESMO) 2019 Annual Meeting.  Continue reading

Laundry Detergent Packets Still Poison Kids, Despite Tougher Standards Interview with:

Dr-Gary A. Smith

Dr. Gary Smith

Dr. Gary Smith, MD MPH
Director, Center for Injury Research and Policy
Nationwide Children’s Hospital
Columbus, OH What is the background for this study? What are the main findings?

Response: Our 2016 study ( investigated calls to US poison control centers related to laundry and dishwasher detergent exposures among children younger than 6 years old from 2013 through 2014 and found that poison control centers received more than 30 calls a day about children who had been exposed to a laundry detergent packet, which is about one call every 45 minutes.

The current study investigated trends in calls to poison control centers across the country for exposure to liquid laundry detergent packets in order to evaluate the impact of the voluntary safety standard for this product with a focus on young children. The study found only a modest decrease (18%) in calls for children younger than 6 years of age following adoption of a 2015 product safety standard as well as an increase in calls for older children and adults. Exposures to the eyes also continued to climb.

The observed decrease in exposures among young children is considerably less than the 40% to 55% decrease in toxic ingestions seen after passage of the Poison Prevention Packaging Act. This demonstrates that the current liquid laundry detergent safety standard is inadequate and needs to be strengthened. Continue reading

Sudden Infant Death Can Occur in Child Seats, esp When Not In Car and Adult Asleep Interview with:

Jeffrey Colvin, MD, JDDepartment of PediatricsChildren's Mercy HospitalKansas City, MO 64111

Dr. Colvin

Jeffrey Colvin, MD, JD
Department of Pediatrics
Children’s Mercy Hospital
Kansas City, MO 64111 What is the background for this study? What are the main findings?

Response: Prior studies have found that infants spend an average of 5-6 hours a day in sitting devices. Sitting devices include car seats, swings, infant seats, and strollers.

Given how much time infants are spending in sitting devices, we wanted to know if sleep-related infant deaths (such as Sudden Infant Death Syndrome or “SIDS”) was occurring in those devices. We examined over 10,000 infant sleep-related deaths from 45 states. We found that 3% (or 348) of the deaths occurred in sitting devices. Two-thirds of the deaths in sitting devices were in car seats. What was most surprising was that less than 10% of the deaths in car seats occurred in cars. Instead, the great majority occurred in the child’s home or the home of a relative, friend, or babysitter. In 1/3 of the deaths in car seats, the supervising adult was asleep.  Continue reading

Pre-Visit Electronic Screening Helps Doctors Counsel Their Adolescent Patients Interview with:

Cari McCarty, PhDResearch Professor, UWInvestigator, Seattle Children’s Research Institute

Dr. McCarty

Cari McCarty, PhD
Research Professor, UW
Investigator, Seattle Children’s Research Institute What is the background for this study?

Response: Adolescence is a time when teens begin to take charge of their health, but it is also a time when they can be prone to health risk behaviors, such as insufficient physical activity, poor sleep, and substance use. We were interested in whether using an electronic health risk screening tool in primary care settings could improve healthcare and health for adolescents.  The tool was designed to provide screening as well as motivational feedback directly to adolescents, in addition to clinical decision support for the healthcare clinician.  We conducted a trial with 300 adolescent patients where one group received the screening tool prior to their health checkup, and the other group received usual care.

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Collaboration and Teamwork Allowed Reduction in Unintended Extubations in Neonatal ICU Interview with:

John P. Galiote, M.D.Neonatologist at Children’s National-Virginia Hospital Center NICU

Dr. Galiote

John P. Galiote, M.D.
Neonatologist at Children’s National-Virginia Hospital Center NICU

Michelande Ridoré, MS, NICUQuality improvement lead at Children’s National 

Ms. Ridoré

Michelande Ridoré, MS, NICU
Quality improvement lead at Children’s National

Lamia Soghier, M.D., MEd, Children’s National NICU medical director

Dr. Soghier


Lamia Soghier, M.D., MEd, Children’s National NICU Medical Director What is the background for this study? What are the main findings?

Response: Our study emphasizes the importance of team work and real-time communication in a quality-improvement project within the neonatal intensive care unit (NICU) setting.

Through bedside huddles, weekly reviews of apparent cause analysis reports reducing the frequency of X-rays and the creation of an Airway Safety Protection Team, we were able to focus not only on  reducing unintended extubations, but also on the quality-improvement project’s effect on our staff. Adhering to simple quality principles enabled us to ensure that all members of our staff were heard and had a positive effect on the progress of our project. This allowed us to implement and sustain a series of simple changes that standardized steps associated with securing and maintaining an endotracheal tube (ET). Unintended extubations are the fourth-most common adverse event in the nation’s NICUs. Continual monitoring via this quality-improvement project allowed us to intervene when our rates increased and further pushed our unintended extubation rate downward. Continue reading

E-Cigs: New Source of Second-Hand Smoke for Children

"E-Cigarette/Electronic Cigarette/E-Cigs/E-Liquid/Vaping/Cloud Chasing" by Vaping360 is licensed under CC BY 2.0 CC BY Interview with:Jenny L. Carwile, ScD, MPH
Department of Medicine
Maine Medical Center
Portland What is the background for this study? What are the main findings?

Response:  Although e-cigarette aerosols are commonly perceived to be “harmless water vapors” they contain numerous potentially harmful chemicals including volatile organic compounds like formaldehyde, nicotine, heavy metals, and ultrafine particulates. Non-users can be exposed to these chemicals through secondhand exposure.

We found that in the US 4.9% of adults who lived in a household with children were current e-cigarette users. Continue reading

Fetal and Early Infant Growth Linked to Persistent Body Fat Patterns Interview with:

Vincent W. V. Jaddoe, MD, PhDAdjunct Professor of EpidemiologyDepartment of Epidemiology

Dr. Jaddoe

Vincent W. V. Jaddoe, MD, PhD
Adjunct Professor of Epidemiology
Department of Epidemiology What is the background for this study? What are the main findings? 

Response: Childhood body fat may be affected by patterns of fetal and infant weight change. Children born small for gestational age (SGA) tend to have infant growth acceleration, whereas those born large for gestational age (LGA) tend to have infant growth deceleration. Little is known about fetal and infant growth patterns affecting visceral, liver, and pericardial fat, which are strongly associated with cardiometabolic disease in later life.

We assessed in a large population cohort study whether fetal and infant weight change was associated with not only general, but also organ fat at school age. We observed that fetal and infant weight change patterns were both associated with childhood body fat, but weight change patterns in infancy tended to have larger effects. Fetal growth restriction followed by infant growth acceleration was associated with increased visceral and liver fat.  Continue reading

How Long Does Protection from DTaP Vaccination Last? Interview with:

Dr. Matthieu Domenech de Cellès PhDBiostatistics, Biomathematics, Pharmacoepidemiology, and Infectious Diseases Unit, Institut Pasteur, Inserm U1181, University of Versailles St-Quentin-en-Yvelines,Versailles, France

Dr. Domenech de Cellès

Dr. Matthieu Domenech de Cellès PhD
Biostatistics, Biomathematics, Pharmacoepidemiology, and
Infectious Diseases Unit, Institut Pasteur, Inserm U1181,
University of Versailles St-Quentin-en-Yvelines,
Versailles, France What is the background for this study? What are the main findings?

Response: Most high-income countries now use acellular pertussis vaccines (called DTaP, which are sub-unit vaccines based on purified antigens of the bacterium Bordetella pertussis) to protect children against pertussis. Although clinical trials demonstrated the short-term effectiveness of DTaP vaccines, there was a growing concern that the duration of protection they conferred was not very long. Those concerns were mostly based on the results of a number of epidemiological studies, which showed that the relative risk of contracting pertussis increased substantially over time, typically by 20–40% every year since last vaccination.

Although such increases seem high, it was not immediately obvious how to interpret them—the more so because pertussis epidemiology is complex.

In our study, we developed mathematical models of pertussis epidemiology to try to understand what the results of recent epidemiological studies really meant about the effectiveness and the duration of protection of DTaP vaccines. The most interesting—and perhaps counterintuitive—finding of our study was that those results are fully consistent with highly effective DTaP vaccines, which confer long-term protection. This is a consequence of the fact that pertussis is highly contagious and that the immunity conferred by DTaP, though very high, is not perfect.    Continue reading

Early Childhood Infections Associated With Eating Disorders In Adolescence Interview with:

Lauren Breithaupt, PhDDepartment of PsychologyGeorge Mason UniversityFairfax, Virginia

Dr. Breithaupt

Lauren Breithaupt, PhD
Department of Psychology
George Mason University
Fairfax, Virginia What is the background for this study? What are the main findings? 

Response: Our study provides novel insight into the relationship between the immune system and eating disorders characterized by chronic restriction (e.g., anorexia nervosa) and binge eating and/or purging (e.g., binge eating disorder, bulimia nervosa). These findings also add to the growing body of literature linking the immune systems broadly and mental disorders.

We found that infections in early childhood were associated with an increased risk of anorexia nervosa, bulimia nervosa, and other eating disorders such as binge eating disorder in adolescence. These relationships appear to be both time and dose-dependent, meaning that the onset of eating disorder diagnosis is greatest in the first three months following the infection, and the more infections, the greater the risk.    Continue reading

To Reduce Crib Deaths, Get Rid of Blankets, Pillows, Bumpers and Soft Objects Interview with:

Fern R. Hauck, MD, MSSpencer P. Bass, MD Twenty-First Century Professor of Family MedicineProfessor of Public Health SciencesDirector, International Family Medicine ClinicUniversity of Virginia Department of Family Medicine

Dr. Hauck

Fern R. Hauck, MD, MS
Spencer P. Bass, MD Twenty-First Century Professor of Family Medicine
Professor of Public Health Sciences
Director, International Family Medicine Clinic
University of Virginia Department of Family Medicine What is the background for this study?

Response: Unintentional suffocation is the leading cause of injury deaths among infants under one year of age in the US. 82% of these deaths are attributed to accidental suffocation and strangulation in bed. The Sudden Unexpected Infant Death Case Registry was established by the Centers for Disease Control and Prevention (CDC) in 2009 to collect data on sudden unexpected infant deaths (SUID) to better understand trends and characteristics associated with these deaths. Data from 10 states, which account for about one-third of all US SUID cases, are captured in the Registry.

The CDC developed the Case Registry classification system in 2014 to differentiate SUID cases into several groups; explained suffocations with unsafe sleep factors is one of those categories, and the subject of this study. We analyzed infant deaths (children under one year of age) that occurred from 2011-2014 among states participating in the registry at the time of the study (Arizona, Colorado, Georgia, Louisiana, Michigan, Minnesota, New Hampshire, New Jersey, New Mexico, and Wisconsin). Among the 1812 cases in the Registry from 2011-2014, 250 (14%) were classified as suffocation. The remaining cases were classified as unexplained SUID.

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Changes in WIC Program Linked to Decreased Obesity in Children Interview with:

M. Pia Chaparro, MS, PhDAssistant ProfessorDepartment of Global Community Health and Behavioral SciencesSchool of Public Health and Tropical MedicineTulane UniversityNew Orleans, LA 70112

Dr. Chaparro

M. Pia Chaparro, MS, PhD
Assistant Professor
Department of Global Community Health and Behavioral Sciences
School of Public Health and Tropical Medicine
Tulane University
New Orleans, LA 70112 What is the background for this study? What are the main findings?

Response: In 2009, the WIC program changed the food packages participants receive to better align them with federal dietary guidelines. These changes included the addition of fruits, vegetables, and whole grains; a reduction in the amount of dairy and juice; and a calibration in formula amounts to match infants’ age and needs.

We found that this change in the food package was associated with a 10-12% lower obesity risk at age 4 years among children who participated in WIC in Los Angeles County continuously from birth until age 4. Continue reading

USPSTF: More Research Needed to Determine What Primary Care Providers Can Do to Detect and Treat Lead Poisoning Interview with:

Alex H. Krist, MD, MPHVice-Chairperson, U.S. Preventive Services Task Force Professor of family medicine and population healt Virginia Commonwealth University

Dr. Krist

Alex H. Krist, MD, MPH
Vice-Chairperson, U.S. Preventive Services Task Force
Professor of family medicine and population healt
Virginia Commonwealth University What is the background for this study? What are the main findings? 

Response: Exposure to lead can have serious lifelong effects on the health and wellbeing of children. There is no safe level of lead exposure, so finding and removing any source of lead exposure is essential.

In its review of the evidence, the Task Force found that more research is needed to determine what primary care clinicians can do to help prevent and treat the health problems that can result from lead exposure in childhood and pregnancy.

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Kids Who Don’t Drink Water, More Likely To Drink Sugar-Sweetened Beverages Interview with:

Asher Y Rosinger, PhD, MPHAssistant Professor of Biobehavioral Health and AnthropologyDirector of the Water, Health, and Nutrition LaboratoryPennsylvania State University

Dr. Rosinger

Asher Y Rosinger, PhD, MPH
Assistant Professor of Biobehavioral Health and Anthropology
Director of the Water, Health, and Nutrition Laboratory
Pennsylvania State University What is the background for this study? What are the main findings?

Response: Sugar-sweetened beverage consumption has been linked to many negative health conditions, such as weight gain, dental caries, and type 2 diabetes. Previous research found that when you replace sugar-sweetened beverages (SSBs) with water intake then total energy intake goes down. We wanted to know how many calories from SSBs children consume when they drink water or not since sugar-sweetened beverages are often used as a replacement for water. SSB intake has been falling among children over the last 15 years, but there are still pockets and sub-populations that have high consumption levels. It is critical to identify which kids are particularly at risk for high SSB intake since this can lead to these negative health effects.

Overall we found that kids that did not consume any plain water (from tap or bottled water) consumed almost twice as many calories and percent of total calories from sugar-sweetened beverages than kids that consumed water. And for the sample overall that translated to nearly 100 extra calories on a given day.  Continue reading

High Lead Levels in Refugee Children Resettled in US Interview with:

Madhav P. Bhatta, PhD, MPHAssociate Professor, Epidemiology & Global HealthCollege of Public HealthKent State UniversityKent, OH 44242

Dr. Bhatta

Madhav P. Bhatta, PhD, MPH
Associate Professor, Epidemiology & Global Health
College of Public Health
Kent State University
Kent, OH 44242 What is the background for this study?

Response: Lead exposure, especially in children, in any amount is harmful. Lead poisoning is a growing global environmental health problem with increasing lead-related diseases, disabilities, and deaths.  While exposure to lead in US children, in general, has significantly declined in the last three to four decades certain sub-groups of US children such as African Americans, immigrants and resettled refugees, and those from lower socioeconomic backgrounds are still vulnerable to environmental lead exposure.

Previous studies among resettled refugee children in the United States had found 4- to 5-times higher prevalence of elevated blood lead level (EBLL) when compared to US-born children. However, most of the studies were conducted when EBLL was defined as blood lead level ≥ 10 µg/dL. In 2012, the US Centers for Disease Control and Prevention changed the reference value for EBLL to ≥ 5 µg/dL. Moreover, because the countries of origin for US resettled refugees change over time, it is important to have epidemiologic studies that provide the current information on EBLL among these vulnerable new US immigrant children.

Using blood lead level data from the post-resettlement medical screening, our study examined the prevalence of elevated blood lead level at the time of resettlement among former refugee children who were settled in the state of Ohio from 2009-2016. We had a large and diverse sample (5,661 children from 46 countries of origin) of children for the study, which allowed us to assess EBLL in children from several countries of origin that had not been previously studied. Continue reading

Pediatric Blood Lead Levels in Public vs Private New York Housing Interview with:

Lead paint can crack and form flakes, which can contaminate the surrounding environment. Source: Wikipedia

Lead paint can crack and form flakes, which can contaminate the surrounding environment.
Source: Wikipedia

Ms. Jacqueline Chiofalo, MPA
Director of Policy Research & Analysis
The Institute for Family Health
Astoria, New York What is the background for this study? What are the main findings?

Response: Exposure to lead is dangerous and has been banned from use in residential dwellings. However, residual sources of lead still exist. Few studies have examined pediatric lead poisoning between public (NYCHA) and private housing units, and no recent studies performed in New York City. Our study used retrospective chart analysis of routine child lead testing to examine the difference in blood lead levels between the two housing types.

Our data showed that children seen in our health centers who lived in New York City public housing had significantly lower mean blood lead levels and fewer children were found with levels over the CDC reference range of 5 μg/dL compared to children who lived in private housing.  Continue reading

Pediatric Melanoma Risk Increasing in Adolescents & Young Adults, Including in Non-Whites Interview with:

Susan M. Swetter, MDProfessor of DermatologyDirector, Pigmented Lesion & Melanoma ProgramPhysician Leader, Cancer Care Program in Cutaneous OncologyStanford University Medical Center and Cancer Institute

Dr. Swetter

Susan M. Swetter, MD
Professor of Dermatology
Director, Pigmented Lesion & Melanoma Program
Physician Leader, Cancer Care Program in Cutaneous Oncology
Stanford University Medical Center and Cancer Institute What is the background for this study? What are the main findings? 

Response: The Stanford Pigmented Lesion and Melanoma and Program and Pediatric Dermatology Division participated in the long-term management of children, adolescents and young adults (<25 years of age) with melanoma and atypical melanocytic neoplasms, including atypical Spitz tumors (ASTs) that may be histopathologically challenging to differentiate from true melanoma.

Over a 23-year period, we have observed increased racial-ethnic diversity in young patients with these diagnoses, especially in the presentation of young individuals with darker skin phenotypes and more clinically amelanotic (nonpigmented) lesions compared to patients with lighter skin.  Continue reading

TRAP: Traffic Related Air Pollution Linked to Millions of Pediatric Asthma Cases Worldwide Interview with:
Ploy Pattanun Achakulwisut, PhD
Postdoctoral Scientist in Climate change, Air pollution, and Public Health
Milken Institute School of Public Health (Anenberg Group
The George Washington University, D.C What is the background for this study?

Response: Dozens of epidemiological studies have found positive and generally statistically significant associations between long-term exposure to traffic-related air pollution (TRAP) and asthma development in children. The evidence is most robust for nitrogen dioxide (NO2), a major component of and commonly used surrogate for the complex TRAP mixture. Recent reviews conducted by the US Environmental Protection Agency and Health Canada concluded that there is “likely a causal relationship” between long-term NO2 exposure and pediatric asthma development.

Using NO2 as a proxy for TRAP, our study provides the first global estimate of the number of new asthma cases among children that are attributable to traffic pollution, using fine spatial-scale global datasets that can resolve within-city and near-roadway NO2 exposures.

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Is There a Risk of Bleeding With Ibuprofen After Tonsillectomy ? Interview with:

Gillian R. Diercks, MD, MPHInstructor in Otolaryngology, Harvard Medical SchoolDepartment of OtolaryngologyMassachusetts Eye and Ear InfirmaryBoston, Massachusetts

Dr. Diercks

Gillian R. Diercks, MD, MPH
Instructor in Otolaryngology, Harvard Medical School
Department of Otolaryngology
Massachusetts Eye and Ear Infirmary
Boston, Massachusetts What is the background for this study? What are the main findings?

Response: Pediatric tonsillectomy is a commonly performed procedure, representing the second most common ambulatory surgery performed on children in the United States, with over half a million children undergoing the surgery annually.  A major concern for surgeons, patients, and their families is the issue of postoperative pain control as pain can last up to 10-14 days after surgery, be quite severe, and result in readmission to the hospital or ED visits for medications and dehydration.

In young children and children with sleep apnea we cannot safely administer narcotic pain medications at home.  This leaves limited options for pain control, including acetaminophen and ibuprofen.  However, there are concerns that ibuprofen could potentially increase bleeding risk after surgery because of its effects on platelet function in the blood.  At baseline, the risk of postoperative hemorrhage within the first two weeks after tonsillectomy is around 4.5%, with about 1-1.5% of children requiring a return to the operating room to control severe bleeding.  Our study set out to show that the risk of severe postoperative bleeding when ibuprofen is given for 9 days after tonsillectomy was not increased compared with the bleeding risk when acetaminophen was administered instead.

Our study could not conclude that the risk of bleeding is no different when ibuprofen is used, and was suggestive that the bleeding risk may actually be higher. Continue reading

Extremely Low Gestational Age Neonates May Benefit From Delayed Cord Clamping Interview with:

Abhay K Lodha Department of PediatricsAlberta Health Services 

Dr. Lodha

Abhay K Lodha MD, DM, MSc
Department of Pediatrics
Alberta Health Services What is the background for this study?

Response: There is no physiological rationale for clamping the umbilical cord immediately after birth. In moderate (32+0 weeks-33+6 weeks) and late preterm infants (34+0 to 36+6), delayed cord clamping reduces the need for blood transfusions, leads to circulatory stability and improves blood pressure.

However, the information on the association of delayed cord clamping with outcomes for extremely low gestational age neonates (22-28 weeks of gestation) is limited.

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Central Care Improved Survival of Extremely Premature Infants Interview with:

Mikael Norman, MD, PhD, ProfessorKarolinska Institutet & Karolinska University HospitalStockholm, Sweden 

Dr. Norman

Mikael Norman, MD, PhD, Professor
Karolinska Institutet & Karolinska University Hospital
Stockholm, Sweden What is the background for this study?

Response: So far, preterm birth has been difficult to predict and prevent. In particular, extremely preterm birth has continued to be an issue in terms of optimal care before and after birth, costs and long term health outcomes. Therefore, studies on how the management and outcome varies over time in these patients are important.

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