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Better Kid Care and Child Development Health

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Better Kid care and Child Development HealthIntroduction:

The following information includes tips on providing better kid care and child development health. We focus on important kids care for maintaining children’s health including basic preventive healthcare, dietary research, vitamin and mineral needs, cold prevention, probiotics and many others. We cover kids health tips and early childhood development needs. Appropriate use of fluoride for the prevention of tooth decay is included. Certain processed foods in a child’s diet or even in the pregnant mother’s diet may negatively impact child health. In children suffering from iodine or iron deficiency, supplementation has been linked with improvement in cognitive function. Cold prevention and some natural treatment options are discussed. Fruit consumption has been linked to improvement of allergic disease in children. Physical activity is also important not only for physical health but also for mental acuity. In addition, there are many other important facts included which may promote health in children.

 

Role of the pediatrician:

A pediatrician is usually assigned to oversee the care of a baby following birth in the hospital. Ensure that a pediatrician is arranged with an appointment prior to the baby’s discharge to home from the hospital for any concerns that arise. For instance, the video below shows how a pediatrition named Dr. Robert Hamilton has determined a way to calm a crying baby. Watch how he does this in the video:

Credits:  Pacific Ocean Pediatrics, http://www.pacificoceanpediatrics.com
Video Production By: Nate Scribner: http://www.natescribner.com/ + Hector Puig: http://www.hectorpuig.com/

Breast Feeding:

Breast feeding an infant is highly recommended instead of using formula or cow’s milk. Pump breast milk to provide breast milk to the infant when the mother cannot be with the baby. When breast milk cannot be used for any reason, use a formula with hydrolyzed whey. Read more.

 

An important treatment for the infant within 1 hour of birth:

At birth, the U.S. Preventive Services Task Force (USPSTF) advises to prevent gonococcal ophthalmia neonatorum (conjunctivitis occurring from bacteria of the birth canal which may result in blindness) with 0.5% erythromycin applied to the newborn’s eyes within 1 hour of birth (1).

 

Blood tests required for screenings at birth:

A screen for congenital hypothyroidism after birth is necessary according to the U.S. Preventive Services Task Force (USPSTF) (2). According the American Academy of Pediatrics, a congenital hypothyroidism screening may not be performed as a routine in many countries, may cause mental retardation, but if diagnosed and treated within 2 weeks, cognitive development will normalize (3).

 

Screening for enzyme deficiency:

The U.S. Preventive Services Task Force (USPSTF) recommends screening newborns between 24 hours and 7 days of age for phenylketonuria (PKU) (4). PKU is a gene mutation causing deficiency of the enzyme used to metabolize phenylalanine which will result in buildup of phenylketone resulting in mental retardation or seizures if not treated (4).

 

Screening for genetic blood disease:

The USPSTF recommends screening newborns for sickle cell disease (5).

 

Hearing test:

The USPSTF supports the American Academy of Pediatrics Joint Committee on Infant Hearing in recommending screening for hearing impairment under 1 month of age, followed by a comprehensive audiological testing by 3 months of age (32,5). Those with hearing loss should be treated to improve hearing by 6 months of age. Primary pediatric care should also provide assessment of communication skill development during routine visits starting at 2 months of age. (7)

 

Iron deficiency:

The U.S. Preventive Services Task Force (USPSTF) recommends prevention of iron deficiency for 6-12 month infants with a low birth weight, premature birth, or those at increased risk to reduce the risk of iron deficiency with formulas and cereals fortified with iron (9). This includes vegetarian children.

 

Maintain follow up intervals at the pediatrician:

The primary care pediatrician should emphasize maintaining compliance and follow-up intervals based on diagnoses, school physicals, or vaccine requirements.

 

Infant and child nutrition:

Infants receiving breast milk and/or an infant formula in most cases contain an adequate amount of water, necessary nutrients and do not normally require any other supplementation. The pediatrician should determine the infant’s intake of breast milk or formula to ensure adequate nutrition and to reduce the risk of dehydration (10). Infants should receive all nutrients from breast milk or formula until food is introduced. Lactating mothers actively breast feeding should follow nutrient guidelines for lactation recommended daily allowances. The pediatrician can often identify possible nutrient deficiencies found in infants consuming breast milk from parents with a nutrient deficiency or those infants which consume cow’s milk only. For example, one of the important nutrients to test for periodically is iron deficiency due to a high prevalence of this deficiency. Have your children avoid concentrated sweets which result in abrupt hyperactivity followed by irritability after the sugar is metabolized. Read More

 

Immunizations:

Complete routine infant and childhood vaccinations. Influenza vaccination should be given each year in October (11). For more information see the immunization schedules posted by the Centers for Disease Control. For those 0-18 years of age please visit the link: CDC Vaccination Schedule.

Centers for Disease Control and Prevention   1600 Clifton Rd. Atlanta, GA 30333, USA 800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 – Contact CDC–INFO

 

Visual impairment:

Children ages 3–5 are recommended by the U.S. Preventive Services Task Force (USPSTF) to have a screening test for visual impairment (12). A common cause of visual impairment is amblyopia or “lazy eye,” which is poor transmission of visual stimulation through the optic nerve often starting in childhood. The condition is treatable by use of eye patch or corrective lenses.

 

Childhood obesity:

The American Medical Association (AMA) adopted a new policy in June of 2013 to classify obesity as a disease. This decision was made not only to improve research, education, and development of treatments for obesity, but also reduce the stigma of being overweight (13). The USPSTF recommends counseling and lifestyle modifications for children with obesity over 6 years old (14). Obese children are at risk of diabetes and other health problem not only at the present time but also in the future.

 

Depression

The U.S. Preventive Services Task Force (USPSTF) recommends screening teenagers between 12 and 18 years old for depression if appropriate professionals are available for accurate diagnosis, effective treatment, and follow-up (15).

Sexually transmitted infections:

The U.S. Preventive Services Task Force (USPSTF) recommends screening sexually active adolescents for sexually transmitted infections (16).

 

Fruits, vegetables, water, and milk consumption

Fruit and vegetable consumption as well as encouraging water and milk intake throughout the day improves the free water reserve and hydration status of children (17). Enhance the fruit and vegetable intake of children with subtle and creative methods. Hydrate often with milk or water with meals and water between meals.

 

Sun exposure

Prevent sun damage of the skin and eyes with sunblock (at least spf 30) and UV eye protection. According to the U.S. Preventive Services Task Force (USPSTF), all young adults age 24 years and younger are specifically recommended to receive counseling on minimizing their exposure to ultraviolet radiation to reduce risk of skin cancer. USPSTF reviewed epidemiology of skin cancer due to UV exposure. They found that children, adolescents, and young adults are at a moderate risk for skin cancer, while adults older than this have a smaller increase in risk. The USPSTF states that sunlight exposure is linked to all 3 types of skin cancer. Melanoma is the rarest but has the highest mortality. Squamous cell is more common but is accountable for a small number of cancer deaths. Basal cell does not usually metastasize and doesn’t result in cancer deaths. Per the USPSTF, counseling should be based on prevention or minimizing sun exposure with clothing, broad spectrum sunblock with minimum of 30 spf, avoiding midday sun 10 am to 3 pm, and avoidance of indoor tanning beds. (18)

 

Sexually transmitted infections

According to the U.S. Preventive Services Task Force (USPSTF), all sexually active individuals at increased risk for sexually transmitted infections are recommended to have high-intensity behavioral counseling to prevent these infections. According to the USPSTF, individuals with current sexually transmitted infections or within the past year are considered to be at increased risk for future sexually transmitted infections. They are also considered increased risk by the USPSTF if adults have multiple current sexual partners or if the medical practice population has a high rate of sexually transmitted infections.(16,19)

 

HIV:

Any individual at risk of HIV infection should be provided informed consent and screened (20).

 

Teenagers and tobacco:

Avoid substance abuse and tobacco abuse. Quit tobacco use as soon as possible by using a combination of several methods to assist in cessation. For instance, combine nicotine replacement with at least one additional method such as an exercise program, hypnosis, or formal counseling such as support groups. The recommendation to counsel patients to stop smoking, stop using tobacco products, and provide methods of cessation is reinforced by the USPSTF (21). Many resources are available to assist in smoking cessation such as the online sites http://smokefree.gov/, http://www.cdc.gov/tobacco/campaign/tips/quit-smoking/ and the phone number for free help 1-800-QUIT-NOW.

 

Awareness:

Keep a watchful eye for unusual changes of the body. Many patients have come to see their doctor after a certain concerning problem has been going on for a year or more or after the problem has become much worse. Look for wounds that are not healing, skin problems, ongoing cough, persistent shortness of breath, unresolved pain, lasting fevers, unexplained weight loss, lumps and other new problems which do not go away or continue to worsen with time.

 

Infants and children daily schedule:

Infants and children do well with predictable schedules for sleep, meals, school and playtime. Avoid erratic sleep patterns which cause unnecessary stress.

 

Vitamin A supplementation in children with measles:

The supplementation of Vitamin A in children with measles was documented to have an association with lower mortality rate in both malnourished and overall healthy children diagnosed with the disease. Vitamin A may reduce in morbidity and mortality by about 50% may also prevent eye damage and blindness. The World Health Organization recommends that all children diagnosed with measles throughout the world receive vitamin A supplementation regardless of which country they live. See vitamin A for more information about this nutrient.

Randomized trials (43 trials total) of oral vitamin A supplements in children aged 6 months to 5 years (n=215,633) were analyzed by Mayo-Wilson E, et al to determine the effect of vitamin A on child mortality. All-cause mortality was reduced by 24% in 17 trials. Mortality associated with diarrhea was reduced by 28% in 7 trails. Reductions in occurrences of diarrhea, measles, and vision problems (night blindness and a medical condition in which the eye fails to produce tears) were reported among those taking vitamin A supplements. In 3 trials, risk of vomiting increased during the first 48 hours of supplementation. These findings are especially relevant to low-income and middle-income countries since most of the studies were conducted in Asia, Africa, and Latin America. (22)

Vitamin A was shown to have beneficial effects on morbidity and mortality rates among children suffering from measles in studies conducted in Africa. A study of children with measles (n=20) in California revealed that 50% suffered from Vitamin A deficiency. Therefore, vitamin A should be evaluated as part of treatment for measles in the US. (23)

A meta-analysis that included 12 controlled trials in developing countries evaluated the effect of vitamin A and child mortality. Results indicate vitamin A taken by hospitalized children suffering from measles has a beneficial effect on mortality. Vitamin A also has a beneficial effect on overall mortality in healthy children. (24)

 

A vitamin deficiency and infant’s refusal of solid foods:

Vitamin B12 deficiency may lead to solid food refusal. A study of an 8-month-old who refused solid foods revealed the infant to be vitamin B12 deficient. After receiving vitamin B12 via other routes besides the mouth, the infant’s health improved and solid foods were introduced successfully. Researchers suggest refusal of solid foods could be used as an early sign of insufficient vitamin B12 levels in breastfed infants. (25)

 

Calcium, vitamin D, height, and weight:

Calcium and vitamin D intake as part of a healthful diet is necessary for development and is recommended for children at the current recommended daily allowances. See calcium and vitamin D section for these intake recommendations. Calcium supplements were not found to influence the growth rate or result in weight gain when taken by children (26).

 

Fluoride for prevention of tooth decay:

For preschool children age 6 months and older whose primary water source is deficient in fluoride, the U.S. Preventive Services Task Force (USPSTF) recommends that primary care clinicians prescribe oral fluoride at currently recommended doses. (48)

Fluoride recommendations by the Centers of Disease Control (CDC): Fluoride helps prevent caries, or tooth decay. Water fluoride concentration in the amounts of 0.7-1.2 parts per million are considered to be safe and effective levels for preventing tooth decay. The CDC recommends drinking water with fluoride and brushing at least 2 times a day with toothpaste containing fluoride.  Parents should also be advised on use of fluoride toothpaste in young children. A small pea-size of toothpaste is recommended in children. Brushing should be supervised since children—especially those under 2 years of age—may swallow or use too much toothpaste that might increase risk of enamel fluorosis (a whitish discoloration of the tooth enamel). Additionally, fluoride supplements and other high concentration fluoride products (professionally applied gels, foams, varnishes) should only be used in children at high risk of tooth decay and those living in places where the drinking water fluoride concentration is low. (27)

Fluoride recommendations by the American Dental Association (ADA): According to the ADA, daily dietary fluoride supplement use should be prescribed to children at high risk of developing caries also known as tooth decay. Fluoride should not be prescribed to a baby under 6 months of age. Water is considered deficient in fluoride if the concentration is under 0.6 mg per liter. The ADA recommends that high-risk children with fluoride in drinking water under 0.3 mg per liter should be prescribed fluoride as follows: 0-6months old: Do not prescribe fluoride. 6 months to 3 years: 0.25 mg per day, 3-6 years old: 0.5 mg/day, 6-16 years old: 1 mg/day. If drinking water contains 0.3-0.6 mg per liter of fluoride, 3-6 year olds should take 0.25mg per day of fluoride, 6 to 16 year olds should take 0.5 mg per day.

It should be noted that the use of fluoride supplements in areas with fluoridated drinking water, or in any circumstance were the child has other sources of fluoride exposure, might increase the risk of enamel fluorosis, changes in the appearance of teeth. (28)

 

Iodine deficiency and children:

Iodine requirements during pregnancy may affect children: Iodine deficiency reduced intelligence in infants and children and thus is of critical importance during pregnancy. While the maximum safe dose is no more than 1 mg, this upper limit might be increased given than the Japanese consume 25 times the median iodine consumption in the US, without adverse effects. More insight might be gained from studies using 3 mg- 6mg iodine which are used to treat fibrocystic breast disease. (29)

 

Iodine supplementation and intelligence testing in children:

Iodine supplementation in children with mild iodine deficiency may improve cognition. Researchers evaluate the effects of iodine supplementation in 184 children (age 10-13) with mild iodine deficiencies. The children were randomly assigned to receive either daily iodine supplements (150 mcg) or placebo daily for 28 weeks. By the end of the study, the children in the iodine group had significantly improved their cognitive scores on 2 out of the 4 tests (from the Wechsler Intelligence Scale for Children) improving picture concepts and matrix reasoning but no gains on letter-number sequencing or or symbol search were made. (30)

Supplementation with 400 mcg iodine (oral iodized oil) daily for 28 weeks improved iodine deficiency, increasing the median iodine level in urine and decreasing thyroglobulin in children (age 10-12). There was no significant difference in the iodine status of the placebo group. Additionally, compared with placebo, iodine treatment significantly improved cognitive performance on 4 of 7 tests (rapid target marking, symbol search, rapid object naming, and Raven’s Coloured Progressive Matrices). (31)

 

Iodine and the thyroid gland:

Iodine and enlargement of the thyroid gland: Rates of swelling/enlargement of the thyroid gland (goiter and iodine status may be improved in children by use of iodine supplementation. This review of 26 prospective controlled trials found a clear association between iodine supplementation (mostly as iodized oil) and goiter reduction. A few, but not all, studies reported an improvement in cognitive and psychomotor measures following iodine supplementation. After supplementation levels of iodine measure in urine increased and reached recommended levels (by the World Health Organization) in most studies. Physical development was not affected (except in one study). There were also only minor side-effects reported (affecting only 1.8% of the 29,613 children in the review). (32)

Azizi F et al found similar results which noted that swelling of the thyroid and thyroglobulin levels were significantly reduced by iodine treatment. (33)

 

Iodine and hearing:

Hearing improved permanently in iodine-deficient children taking continuous iodine supplementation. Schoolchildren in areas of severe iodine deficiency were included in this study. (33)

 

Iron supplementation, anemia and intelligence:

Iron supplementation improved attention and concentration in women and adolescents and increased intelligence (IQ by 2.5 points) in women and children who were anemic. Fourteen randomized controlled trials were included. Iron supplementation had no effect on non-anemic individuals or on other cognitive outcomes (memory, psychomotor skills or school achievement). (34)

A review of studies of iron supplementation (including oral or parenteral administration, fortified formula milk or cereals) found it has a beneficial effect on mental development, in particular for intelligence scores (IQ) in children 7 years or older, and in those who are initially anemic or iron-deficient anemic. The studies were grouped and analyzed in terms of mental or intelligence scores and motor development outcomes. Using a variety of scoring methods and putting all the results of the studies together, cognitive development was significantly improved by iron supplementation of children particularly in ages over 7 or those with a previous documented iron deficiency. There was no evidence to prove iron supplements improved cognitive development for children under age 27 months. However, the data showed no significant effect on motor development nor were there benefits observed in terms of psychomotor development and Bayley Psychomotor Development Index scores. (35)

Iron supplementation health benefits and risks: A review of 26 randomized controlled trials looking at the effects of iron supplementation in children (aged 0-59 months) found that among iron-deficient or anemic children iron supplementation improved hemoglobin (protein that carries oxygen) levels and improved mental and motor development (specially with long-term supplementation). However, iron supplementation negatively affected weight gain in children with low iron. Most studies found no impact on rate of disease in a population (morbidity). Additionally, in populations with high rates of malaria, iron supplementation was associated with a significant increase in serious side-effects. (36)

Iron absorption from infant cereal vs. formula: Iron absorption was studied among infants using iron supplementation of infant cereals and in milk- and soy-based formulas. Iron supplementation in cereals did not provide a good source of iron for infants. Sodium iron pyrophosphate and ferric orthophosphate were not well absorbed (mean, smaller than 1%). Mean absorption for iron of very small particle size was 4.0% and 2.7% for ferrous sulfate. However, results were more promising for iron supplementation in formulas. Ferrous sulfate in milk- and soy-based formulas gave a mean absorption of 3.4% and 5.4%. Iron supplements in milk- and soy-based formulas may meet the dietary needs of infants. (37)

 

Riboflavin and children:

A retrospective study on riboflavin for children, adolescents: Riboflavin, also known as vitamin B2, was reported to be an effective treatment for migraine headaches in children and adolescents. In this retrospective study, 41 participants received either 200 or 400 mg/day of riboflavin orally for 3, 4, or 6 months. At the end of the study, the number and severity of migraine attacks significantly decreased during treatment. Seizures and convulsion were effectively treated with drugs taken after a migraine begins in 77.1% of patients. Additionally, during follow up, a reduction by at least 50% in the number of migraine headaches was reported in 68.4% of patients and in intensity in 21%. (38)

A study with riboflavin for children and adolescents: A randomized, double-blind study of 48 children suggests that riboflavin, also known as vitamin B2, is not an effective treatment for migraine headaches. For 4 weeks, participants received either 200 mg/day of riboflavin or placebo. At the end of the study, a reduction by at least 50% in the number of migraine headaches was reported in about 44% of treatment participants and 67% in the placebo group. (39)

 

Dangers of processed and cured meats:

Some cohort studies have shown that consumption of certain meats either by the pregnant mother, or by the child may result in an increased risk of childhood cancers. In the studies below, the odds ratio was used to calculate risk. Odds ratio is the odds of an event occurring in the exposed group comp…ared to the odds of it occurring in the group which is not exposed. An OR of 1 means that both groups have the same odds. An OR of 1.5 means that the risk is 50% greater. An OR of 2 means that the risk is doubled, and so forth.

A cohort study examined the relationship between maternal consumption of meats cured with sodium nitrate on the risk of brain tumors among their children. Nitrites, preservatives used in meat to combat botulism (a form of food poisoning), combine with amines naturally present in meat to form carcinogenic N-nitroso compounds. These compounds have been associated with cancer of the oral cavity, urinary bladder, esophagus, stomach and brain. The researchers interviewed mothers of 549 children under age 20 with a primary brain tumor diagnosed during 1984-1991 and 801 children without cancer. Researchers found an increased brain tumor risk in offspring of mothers with relatively high consumption levels of nitrite from cured meats during their pregnancies; OR = 2.1 for eating at least twice a day compared to not eating. Increasing average daily grams of cured meats or mg of nitrite from cured meats also increased risk (P for each <0.005), however, nitrate from vegetables did not have the same effect. Finally, researchers found that prenatal vitamins taken throughout pregnancy decreased the risk of cancer in offspring (OR=0.54). This study suggests that exposure to N-nitroso compounds, found in cured meats, during pregnancy may be associated with brain tumors in children. (40)

A study analyzed the possible relationship between a pregnant mother’s diet and the child’s risk of childhood cancer. The study compared 234 cancer cases (including 56 acute lymphocytic leukemia, 45 brain tumor) to 206 randomly selected control cases in Denver. The authors found that children whose mothers consumed one or more hot dogs per week during pregnancy had twice the normal risk of developing brain tumors (OR = 2.3). The odds ratio is the ratio of the odds of an event occurring in one group to the odds of it occurring in another group and an OR of 1 means it equally occurred in both groups. Among children, eating hamburgers one or more times per week was associated with risk of lymphocytic leukemia (OR = 2.0) and children who consumed one or more hot dogs per week were also at higher risk of brain cancer (R = 2.1). Hot dogs contain nitrites that are used as preservatives, primarily to combat serious food poisoning know as botulism, which form compounds associated with cancer. This study suggests that pregnant women may want to cut hot dogs and other processed meats such as bologna, sausage, pepperoni and other packaged luncheon meats out of their diets. (41)

Consumption of processed meats in by children: In this case-control study, Peters et al. studied the relationship between the intake of certain foods (in particular: bacon, sausage, ham, salami, pastrami, lunch meat, corned beef, bologna, hot dogs, oranges and orange juice, grapefruit and grapefruit) and the risk of leukemia in children from birth to age 10 in Los Angeles County between 1980 and 1987. The study found that children eating more than 12 hot dogs per month have 9 times the normal risk of developing childhood leukemia (odds ratio [OR] = 9.5). A strong risk for childhood leukemia also existed for those children whose fathers’ intake of hot dogs was 12 or more per month (OR = 11.0). Consumption of fruit was not found to provide any protection. (42)

 

DHA (Docosahexaenoic acid) in children:

DHA (Docosahexaenoic acid) in 7-9 year old children: Richardson AJ et al performed a randomized, double blind placebo controlled trial in which a total of 362, 7-9 year-old children were administered 600 mg of DHA or vegetable oil placebo per day. The initial reading ability of 224 children which scored equal to or under the 20th percentile gained a reading age of 0.8 months more in scores with the DHA supplement. Those that were initially in the 10th percentile or under gained 1.9 months in reading age score. There was no significant improvement in the working memory of children taking DHA. This study also evaluated 14 specific measurements of an ADHD (Attention Deficit Hyperactivity Disorder) symptom scale in the children such as restlessness, change in mood, and resistant behavior. There was a significant placebo effect, but a significant amount of improvement in 8 of the 14 ADHD parameters measured over placebo. The parents of the children noted the benefit, but no significant improvement was seen by the teachers. (43)

 

Children on a vegetarian diet:

Children aged 5-11 on vegetarian diets have been found to have much lower blood levels of vitamin D than children on omnivorous diets. In vegetarian children, daily intake of vitamin B12 was found to be normal, iron intake was found to be adequate, folate and vitamin A were higher, and vitamin E levels were slightly lower. (44)

Children on a vegetarian diet may be at risk of multiple nutrient deficiencies such as iron, vitamin B12, and vitamin D. These nutrients are discussed elsewhere in Preventive Health Advisor.

 

Caffeine and sleep patterns:

Consuming greater amounts of caffeine leads to shorter sleep duration, longer awake time, and increased sleep during the day, or napping, in adolescents. A total of 191 high school students took part in a 14-day study by Pollak and Bright. Caffeine consumption ranged between 0 and 800 mg/d. The average over 2 weeks went up to 379.4 mg/d. Participants reported on the time they went to bed and woke up, any caffeine intake, and any naps they took. At the end of the study, the researchers found that teens with higher caffeine intake slept fewer hours at night and took more naps during the day than those who had less caffeine. (45)

 

Glucomannan and constipation:

Glucomannan, a water-soluble dietary fiber that is derived from the konjac root, may help treat childhood constipation. The study involved 46 chronically constipated children, each of whom was treated with either glucomannan taken as 100 mg/kg body weight daily (maximal 5 g/day) with 50 mL fluid/500 mg or matching placebo for 4 weeks. Among the 31 children who completed the study (average age was 7 years old), researchers found that glucomannan was more effective in alleviating constipation with 45% of children successfully treated (vs 13% for placebo).  Glucomannan also appeared to reduce abdominal pain. (46)

 

Peppermint oil and irritable bowel syndrome:

A total of 42 children with irritable bowel syndrome (IBS) were included in a randomized, double-blind controlled trial testing the effectiveness of coated peppermint oil capsules containing 187 mg of peppermint oil. The capsules were designed to be digested in the intestine. Participants were randomized to receive treatment or placebo (1 capsule 3 times daily for those weighing 30-45 kg or 2 capsules 3 times daily for those more than 45kg) for 2 weeks. At the end of the study period, severity of pain due to IBS was reduced in 75% of those taking peppermint oil. (47)

 

Pelargonium sidoides and strep throat:

A double-blind, placebo-controlled study enrolled 143 children aged 6-10 years with a strep throat. Pelargonium sidoides extra was found to reduce the total duration of a nondangerous form of strep throat (non-group A beta hemolytic strep tonsillopharyngitis) by 2 days (on average) in the treatment group (n=73) as compared to the placebo group (n=70). Tonsillopharyngitis severity Score from baseline to day four decrease was 7.1 points in the treatment group versus 2.5 points for placebo. Treatment was considered safe by the authors. (48)

 

Preventing the spread of the flu:

According to the Centers of Disease Control, prevention of the flu starts with vaccination for anyone 6 months and older at the start of each season in October. Symptoms of the flu initially include body aches, chills, fever, fatigue, nausea, and vomiting. Within 2 days, sneezing, cough, sore throat, and rhinorrhea set in. Complications of the flu may include pneumonia, encephalitis, meningitis, and seizures.  With any suspicion of the flu, prevent the spread to others by washing hands after touching the face nose or eyes and use hand sanitizer when hand washing not available. Cough should be contained into a tissue or into the sleeve at the elbow since it can be transmitted by air droplet exposure. Do not share utensils and drinking cups. A surgical mask or any simple mask which covers the mouth and nose will help prevent exposure to others. Spreading the flu virus to others is of greatest concern in patients younger than age 2 or over 65 years old, patients in a nursing home, pregnancy, or those with chronic diseases of the lungs, heart, kidneys, cancer patients especially those on chemotherapy, and patients with diabetes. Within 24 hours of onset of symptoms, the physician may prescribe anti-viral medication which may reduce the duration of the illness but in mild cases it is not needed. (49)

Finkelstein S et al released a public health article on flu prevention beyond just vaccination and expressed the importance of practicing personal hygiene, wearing face masks, and using air filters all of which was determined beneficial in reducing the risk of the care giver or other individuals from also getting the flu (50).

Researchers conducted a study of the effect of intensive hand hygiene on school absentees due to influenza-like illness (ILI), diarrhea, conjunctivitis, and laboratory-confirmed influenza in children from 60 different elementary schools in Egypt. Children in the treatment group washed their hands twice a day and received health message reminders. At the end of the study, compared with results for the control group, the intervention group reported a reduction in absences caused by ILI, diarrhea, conjunctivitis, and laboratory-confirmed influenza of 40%, 30%, 67%, and 50%, respectively. (51)

 

Fruit consumption, lung function, and wheezing in children:

Wheezing and dietary modifications: In the cross-sectional study of 2,650 children aged 8-11 years old in the UK, Cook and colleagues reported that forced expiratory volume in 1 second (FEV1), a measure of lung function, was positively linked with the frequency of fresh fruits, green vegetables, and salad consumption but was not associated with blood vitamin C levels. The beneficial effect was strongest from fruit consumption. Compared to children who never ate fresh fruit, those who ate fresh fruit more than once a day had a 79 ml or 4.3% higher FEV1 value. This link between FEV1 and fruit intake was stronger in children with wheeze than those without. (52)

Children and fruit consumption: Children who consume vitamin C-rich fruit are less likely to experience wheezing—a breathing disorder associated with asthma. In this study, children (n=18,737; 6-7 years old) who ate kiwi or citrus fruits 5 to 7 times a week were about 30% less likely than other children who ate fruit less than once a week to suffer from wheezing [odds ratio (OR)=0.68], chronic coughing (OR=0.75), nighttime coughing (OR=0.73), or non-coryzal rhinitis (OR=0.72). The beneficial effect of vitamin C rich fruit was seen even in children with fruit consumption of only 1 to 2 times per week. Fruit consumption appeared to be most beneficial among children who already had asthma. Asthmatics who ate fruit once a week had a 1-year occurrence of wheeze of 29.3% compared with 47.1% for asthmatic children who ate fruit less than once a week. (54)

 

Andrographis paniculata (kan jang) and symptoms of the common cold:

A three-group study of 130 children (mean ± S.D. age, 6.89 ± 0.18 years) treated for the common cold compared echinacea purpurea (L.) extract plus standard treatment, Andrographis paniculata N. extract Sha-10 (AP) (kan jang) plus standard treatment, and standard treatment alone. AP and echinacea are herbs believed to reduce symptoms of common colds. Standard treatment for the control group (n=39) consisted of warm drinks, throat gargles with matricaria (chamomile) infusion, antiseptic nose drops of silver nitrate colloid p.r.n., and acetaminophen (pain-killer) 500 mg three times daily if fever or severe headache was present. The AP group (n=53) was administered as two tablets three times daily for 10 days (30 mg of andrographolide and deoxyandro-grapholide per day). The echinacea group (n=41) received 10 drops three times daily for 10 days. Echinacea administration was expressed as milligrams of echinacea pressed juice per 100 mL of oral solution; the milligram dosage was not reported. The echinacea product contained 20% alcohol. An improvement in upper respiratory tract infection symptoms by days 2−3 was reported in all groups. The authors reported a significantly faster improvement in symptoms in the AP group and a decrease in nasal secretions in the AP and echinacea groups. AP treatment was well tolerated with not reported side-effects. (55)

 

Concerns for parents with young athletes:

Arrhythmias and sudden cardiac death (SCD): Arrhythmias (abnormal heart rhythm) may cause symptoms of transient palpitations, chest pressure/pain, lightheadedness and shortness of breath. All arrhythmias require Cardiology referral for evaluation and treatment. From a prevention perspective for any age patient with a history of ventricular arrhythmia, frequent premature ventricular contractions (PVCs) or any type of heart disease, it is important that a patient have risk for SCD determined. Hospitalized patients for cardiac or other reasons may have an arrhythmia or frequent PVCs seen on telemetry and not receive follow up. In this case a patient may have the primary physician help the patient obtain hospital records or the patient may obtain this on their own by signing a consent in the medical records department.

Young athletes and sudden cardiac death according to the Mayo Clinic (56): Sudden cardiac death in young athletes practicing in competitive sports is rare but unfortunately, this may occur without warning. There are some symptoms if experienced by a young athlete, which should be closely examined prior to allowing any child or adolescent participate in sports. These include any symptoms of lightheadedness, passing out, fainting, chest pain, shortness of breath without known cause, or seizures especially during physical activity. These symptoms should warrant screening with an electrocardiogram (EKG) and echocardiogram. Factors such as young cardiac related death in the family or unexplained death for a family member under 50 years old should also be reason to have this screening performed.

According to a study in Italy by Corrado D et al, the rate of mortality due to sudden cardiac death was reduced in athletes by 90% after screening all with pre-participation history and physicals plus electrocardiogram (EKG) then additional testing with echocardiogram and other directed testing based on positive findings. An electrocardiogram (EKG) was found by the authors to have adequate sensitivity and specificity for detecting cardiomyopathy and a future possibility of arrythmias. (57)

 

Specific problems which are associated with sudden cardiac arrest (58,59):

 

ACC/AHA/ESC published basic guidelines for the prevention of sudden cardiac death (SCD):

The American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee (ACC/AHA/ESC) published guidelines for the prevention of sudden cardiac death (SCD). The SCD of young athletes is rare, but electrocardiogram (EKG) is usually indicated prior to competitive sports and may reveal abnormalities. An echocardiogram may also be considered prior to participation in competitive sports. (59)

 

Probiotic supplements and atopic dematitis:

Atopic dermatitis (eczema) is a long-term (chronic) skin disorder that involves scaly and itchy rashes that is the most common allergy in babies and small children. In this review, researchers looked for trials testing whether or not probiotic supplements use during pregnancy and early life can prevent this type of dermatitis in infants and young children. Probiotics are “friendly bacteria” naturally found in yogurt. Probiotic tablets or liquid supplements can be used by pregnant women or by babies. The reviewers found 14 studies, mostly done between 2007 and 2011. They found a roughly 20% reduction in the rate of atopic dermatitis ((RR = 0.79). The results suggested that probiotics have a moderate role in the prevention of atopic dermatitis. It does not appear to matter at what time the probiotics are consumed (pregnancy or early life) nor who consumed them – child, mother or both. (60)

 

Strength training for children, adolescents:

Evidence suggests that given proper supervision and appropriate program design, young athletes—both children and adolescents—may safely increase muscular strength through strength training. Findings show that the increase in strength is related to the intensity and volume of exercise and is a result of increased neuromuscular activation and coordination, rather than muscle hypertrophy. Any strength gained through exercise is reversible when the training is discontinued. In summary, young athletes can increase muscular strength through resistance training and are at no greater risk of injury than young athletes not performing such training. (61)

 

Physical activity and cognition in children:

Meta-analysis on exercise and cognitive function: Literature on the link between child exercise and cognitive function was reviewed in this meta-analysis that identified 44 such studies that yielded 125 comparisons for analysis. The overall effect size (ES) of 0.32 indicated that physical activity was significantly related to improved cognition in children. Physical activity improves a youth’s perceptual skills, intelligence quotient, achievement, verbal tests, mathematic tests, developmental level and academic readiness. Effect size was largest for tests of perceptual skills (ES=0.49), followed by IQ (ES=0.34), and then math tests (ES=0.20) and verbal tests (ES=0.17). The effect of physical activity was greatest for middle school and young elementary age children (ES=0.40). (62)

Ideal duration of daily physical activity for children: In the Journal Pediatrics, a study reviewed 850 articles that discussed how physical activity influenced the health and behavior of 6 to 18 year olds. It was determined that the ideal duration for fitness benefit of school-age children should be participation in 60 minutes or more of moderate to vigorous physical activity per day. The activity must be developmentally appropriate, enjoyable, and involve a varied number of activities. (63)

 

 

 

Assessment and Plan: Basic Standard Preventive Healthcare for Infants, Toddlers, Children, and Adolescents

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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