Extreme eating problems in early childhood linked to higher chance of developmental delay, NIH study suggests

Young children with a history of eating problems in the first three years of life were more likely to receive low scores on assessments of child development, according to a study by researchers at the National Institutes of Health.

The findings suggest that children with multiple eating problems — frequent crying during meals, pushing food away, gagging and others — may benefit from screening for developmental delay. Early diagnosis of developmental disorders is key to getting children the help they need.

The study was conducted by Diane Putnick, Ph.D., and colleagues in the Epidemiology Branch of NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

Researchers analyzed data on more than 3,500 children from Upstate KIDS, a study of children born between 2008 and 2010 in New York State. Mothers responded to questionnaires, rating their children’s eating patterns and developmental milestones when the children were 18, 24 and 30 months old. Compared to children who did not have eating problems, children who scored high on eating problems at one or two time points were more than twice as likely to miss a developmental milestone. Children with feeding problems at all three ages were four or more times as likely to miss a milestone.

The researchers noted that feeding problems likely don’t cause developmental delay. Rather, problems associated with developmental delay, such as undiagnosed neurological issues, communication difficulties or lack of fine motor skills may underlie feeding problems. They added that feeding problems only at 18 and 24 months could potentially result from temporary variations in maturation. Children with feeding problems that persist until 30 months, however, are at greatest risk for developmental delay and are the strongest candidates for screening.

Children of cancer patients are too often excluded from the disease journey, research shows

The announcement of a cancer diagnosis abruptly and durably alters the course of daily life – not just for the person receiving it, but also for their family.

New research to be presented at the ESMO Congress 2021 suggests that adequate communication and support for children of cancer patients still represents a significant unmet need that parents require help to fulfil.

In 2020, an estimated 4.6 million individuals aged 20 to 54 years were diagnosed with the disease at a time of their lives when they are most likely to be raising children.

The impact of parental cancer on a child’s development varies according to the child’s age and the evolution of the illness, but also, crucially, depending on how the child has been included in the parent’s disease journey.

Giving bad news to their children and addressing the distress this may cause them is one of the most daunting tasks that parents face at a time when they must process their own emotions about the disease.

Yet according to Prof. Carlo Alfredo Clerici, a clinical and child psychology expert from University of Milan, Italy, not involved in the study, “Current psychological perspectives see a certain degree of information to children about their parents’ disease, and about the possibility of their death, as useful and protective against traumatic phenomena.”

Ignorance is not bliss when a parent has cancer.

The social and cultural resistance that often stands in the way of this type of dialogue with children is evident from the results of a survey of 103 patients in Tunisia, almost 90% of whom reported communication disorders on the subject of the parent’s illness and more than 40% choosing not to disclose the whole truth about their disease.

According to study author Dr. Sinen Korbi, Institute Salah Azaiez, Tunis, the idea is widespread among patients that they are protecting their children’s psychosocial equilibrium by shielding them from the reality of the illness.

“This was cited as a concern by seven of the 18 parents in our study who chose to conceal the truth from their children entirely,” he reported, adding that these represent missed opportunities to give hope to children at a time when, even in Tunisia where many cancers are diagnosed at an advanced stage, people do recover from the disease.

Almost all study participants (96%) observed behavioural changes in their children ranging from anxiety and depression, through academic difficulties all the way to violence and substance abuse – but only nine parents consulted a child psychiatrist.

“Many people think they can handle these issues on their own or with help from relatives, but they need to be encouraged to report these problems to us so we can refer them to specialists if needed: this can be as simple as asking patients how their children are doing every time we see them,” said Korbi.

“This study makes clear the need to increase knowledge about the role of psychological and emotional dimensions in people’s lives.Efforts should be made to better understand and take into account, in a way that is compatible with social >and cultural perspectives, the fact that children build their own interpretation of life and that they can suffer significantly when they do not have adults helping them to stay in contact with reality,” said Clerici. “Future research should also aim to capture traumatic phenomena that unfold over time and which are associated with more worrying long-term consequences than the individual symptoms of distress reported here.”

Trauma becomes particularly likely when a child is confronted with a parent’s death from cancer. Communication with children about the disease should be an ongoing process that, ideally, would begin shortly after the announcement of an incurable cancer diagnosis and include practical preparations for life after the parent has died.

These key conversations should be addressed in an age-appropriate way, but parents, who need guidance from professionals, mostly navigate the experience on their own, while health and social care professionals are often unaware of the challenges faced during this period.

Distinguishing between how much it is possible to prepare a child for the loss of a parent to reduce traumatic phenomena and the extent to which this loss constitutes a suffering that words can neither prevent nor mitigate, Clerici underlined the importance of recognising that the support needs of children are not limited to the terminal phase of the disease and early stages of bereavement.

“Their entire growth path will be shaped by the challenge of finding in the surviving parent, in new social and emotional relationships, opportunities to make up for their loss,” he said. “Activating care resources that ensure long-term psychological support and monitoring of the child could help these individuals face the challenges of existence without feeling emotional loneliness or abandonment and, while meeting modest reimbursements from health systems, has the potential to produce significant healthcare savings in the long term.”

NIH-funded study shows screening device accurately detects amblyopia (lazy eye)

A handheld screening device that detects subtle misalignment of the eyes accurately identifies children with amblyopia (lazy eye), according to a study published in the Journal of the American Association for Pediatric Ophthalmology and Strabismus.

“The findings suggest that pediatricians and other primary care providers could use the device to catch  amblyopia at an early age when it’s easier to treat,” said Michael F. Chiang, M.D., director of the National Eye Institute (NEI), which supported research and development of the device. NEI is part of the National Institutes of Health.

Amblyopia is impaired vision in one eye and it is the leading cause of preventable monocular (single eye) vision loss, affecting three of every 100 children in the U.S.

During early childhood, our developing brains learn how to take images from each eye and fuse them into a single image to produce vision. Amblyopia develops when misalignment of the eyes (strabismus) or decreased acuity in one eye interferes with the brain’s ability to process visual information from both eyes, causing it to favor one eye. Once a child is visually mature, vision lost in the weaker eye cannot be corrected with glasses or contact lenses.

Children with amblyopia can suffer from poor school performance and impairments in depth perception and fine motor skills such as handwriting and other hand-eye coordinated activities.

Treatment of amblyopia generally involves placing a patch over the good eye to improve vision in the weaker eye. Patching is less successful as children get older, making early detection crucial. However, this depends on timely diagnosis by the child’s doctor, and most pediatricians are equipped only for basic eye chart vision screening tests, which are not useful for detecting amblyopia in very young children.

The screening device works by assessing the eyes’ ability to fixate together. Held 14 inches from the eyes, the child fixates on a smiley face while the device simultaneously scans both retinas. The scan involves a polarized laser that probes nerve fibers in an area of the light-sensing retina called the fovea, which is important for central vision. Even a subtle misalignment of the foveas — called small-angle strabismus — can interfere with the brain’s ability to integrate images from both eyes. The device calculates a binocularity score that indicates whether the child requires referral to an eye health physician for further investigation.

For the study, 300 children, ages 2 to 6 years, with no known eye disorders were recruited during previously scheduled visits to two Kaiser Permanente Southern California pediatric clinics.

Two non-ophthalmic research associates who were trained how to use the device screened each child, and the results were compared against those from an eye examination performed by a pediatric ophthalmologist who was unaware of the device’s results.  The device detected all six cases (100% sensitivity) of amblyopia and/or strabismus that had been confirmed by the professional eye examination. The device also flagged an additional 45 children as possibly having amblyopia and/or strabismus who were later determined by the eye examination to be normal (85% specificity).

“In the hands of a trained user, it takes 28 seconds to sit the child down, perform the test, and record the results – provided that the child cooperates — which is an important consideration for its adoption in busy pediatric care settings,” said the study’s co-lead investigator, Shaival S. Shah, M.D., a pediatric ophthalmologist at Kaiser Permanente based in Tustin Ranch, California. The test itself requires just 2.5 seconds of a child’s attention.

A key limitation of the study was that the device was not compared with currently available photo-screening devices. Such devices detect differences in light reflexes in each eye and produce images that can help detect risk factors for amblyopia, but not amblyopia itself, which can result in both over and under detection of amblyopia.

By contrast, the pediatric vision scanner detects the presence of amblyopia as opposed to the risk factors of amblyopia, which may lead to fewer unnecessary referrals to pediatric ophthalmologists.

The pediatric vision screener tested in the study is a prototype of blinq. ®, a device that was cleared by the U.S. Food and Drug Administration in 2016.

The clinical trial identifier is NCT02536963. The study was supported by NEI grant R44EY025926 to Rebiscan, Inc. (doing business as Rebion), the Boston-based firm that markets blinq.®. Support was provided under the Small Business Innovation Research (SBIR) program, a funding mechanism that helps independently owned companies with 500 or fewer employees bring biomedical technologies to the market.

Co-founder of Rebion, David Hunter, M.D., Ph.D., ophthalmologist-in-chief at Boston Children’s Hospital, co-invented blinq.® with support from NEI grant R01EY012883.

More than 1.5 million children lost a primary or secondary caregiver due to the COVID-19 pandemic

More than 1.5 million children around the world are estimated to have lost at least one parent, custodial grandparent, or grandparent who lived with them due to death related to COVID-19 during the first 14 months of the pandemic, according to a study published today in The Lancet. 

The study highlights orphanhood as an urgent and overlooked consequence of the pandemic and emphasizes that providing evidence-based psychosocial and economic support to children who have lost a caregiver must be a key part of responding to the pandemic.

The analysis used mortality and fertility data to model rates of COVID-19-associated orphanhood (death of one or both parents) and deaths of custodial and co-residing grandparents (ages 60-84) from March 1, 2020 to April 30, 2021, across 21 countries. This study was funded in part by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

In the paper, “COVID-19-associated deaths” referred to the combination of deaths caused directly by COVID-19 and those caused indirectly by other associated causes, such as lockdowns, restrictions on gatherings and movement, decreased access or acceptability of health care and of treatment for chronic diseases.

Traumatic experiences, such as the loss of a parent or caregiver, are associated with increases in substance use, mental health conditions, and other behavioral and chronic health conditions. NIDA supports research aimed at understanding the impact of trauma on young people, preventing substance use after experiencing hardship, and treating substance use in populations that experience trauma.

“Studies like this play a crucial role in illuminating the COVID-19 pandemic’s long-lasting consequences for families and the future mental health and wellbeing of children across the globe,” said NIDA Director Nora D. Volkow, M.D. “Though the trauma a child experiences after the loss of a parent or caregiver can be devastating, there are evidence-based interventions that can prevent further adverse consequences, such as substance use, and we must ensure that children have access to these interventions.” 

To estimate pandemic-associated orphanhood and caregiver deaths, the study used excess mortality and COVID-19 mortality data for 21 countries that accounted for 77% of global COVID-19 deaths during 2020 and early 2021. These include Argentina, Brazil, Colombia, England and Wales, France, Germany, India, Iran, Italy, Kenya, Malawi, Mexico, Nigeria, Peru, Philippines, Poland, Russian Federation, South Africa, Spain, United States, and Zimbabwe.

The authors estimate that 1,134,000 children lost a parent or custodial grandparent due to COVID-19-associated death. Of these, 1,042,000 children were orphaned of a mother, father, or both – most lost one, not both parents. Overall, 1,562,000 children are estimated to have experienced the death of at least one parent or a custodial or other co-residing grandparent (or other older relative).

The countries with the highest numbers of children who lost primary caregivers (parents or custodial grandparents) included South Africa, Peru, United States, India, Brazil, and Mexico. The countries with rates of COVID-19-associated deaths among primary caregivers (>1/1000 children) included Peru, South Africa, Mexico, Brazil, Colombia, Iran, United States, Argentina, and Russia.

The study found that for every country, COVID-19 associated deaths were greater in men than women, particularly in middle- and older-ages. Overall, there were up to five times more children who lost a father than who lost a mother.

“We know from our research that loss of a parent or caregiver can upend children’s lives and potentially affect their development if they are not in a stable home setting. If we take into consideration variants of concern or possible severity of illness among youth, we must not forget that the pandemic continues to pose a threat to parents and caregivers – and their children,” said Chuck A. Nelson, III, Ph.D., study author, Boston Children’s Hospital.

While research on the science of substance use and addiction remains the primary focus of NIDA’s work, NIDA is supporting COVID-19 research, and has issued over $15 million in funding for COVID-19-related projects since the start of the pandemic that could leverage current infrastructure, projects, or scientific knowledge and resources.

Study links sleep apnea in children to increased risk of high blood pressure in teen years

Children with obstructive sleep apnea are nearly three times more likely to develop high blood pressure when they become teenagers than children who never experience sleep apnea, according to a new study funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health. However, children whose sleep apnea improves as they grow into adolescence do not show an increased chance of having high blood pressure, which is a major risk factor for heart disease.

The long-term study, one of the largest of its kind in the pediatric population, underscores the seriousness of sleep apnea in children and the importance of early treatment, the researchers said. Their findings appear online in the journal JAMA Cardiology.

Obstructive sleep apnea, a common sleep disorder that affects millions worldwide, causes people to briefly and repeatedly stop breathing during sleep. While it occurs mostly in adults, an estimated 10% of school-aged children can also suffer from it. Although almost half of them outgrow the disorder by the time they reach adolescence, another half remain with a chronic and persistent problem. As physicians cannot accurately predict who will outgrow sleep apnea, early treatment may be beneficial to the long-term cardiovascular health of children, the researchers suggest.

While past studies have linked sleep apnea to high blood pressure and an increased risk of heart disease in adults, few have examined the long-term health impact of the disorder in children as they transition to adolescence, said lead study author Julio Fernandez-Mendoza, Ph.D., an associate professor at the Sleep Research and Treatment Center at Penn State College of Medicine in Hershey, Pennsylvania.

“Our study showed that pediatric sleep apnea can act as a gateway to future hypertension,” Fernandez-Mendoza said. “Because most cases of sleep apnea go undiagnosed in adults and children alike the problem needs more attention. Sleep apnea and its risk factors should be screened for, monitored, and targeted early in life to prevent future cardiovascular disease.”

Marishka Brown, Ph.D., director of the NHLBI’s National Center on Sleep Disorders Research, noted that most of the sleep apnea findings in pediatric patients focus on the disorder’s behavioral effects, such as sleepiness, hyperactivity, and cognition.

“There is limited data on either the short- or long-term impact on cardiovascular risk in this population,” she said. “The new findings address this knowledge gap and raise awareness of sleep-disordered breathing in children as a public health problem.”

In the study, the researchers enrolled 421 children ages 5 to 12 years and monitored them overnight in a sleep lab. They found that about 12% had obstructive sleep apnea according to pediatric diagnostic criteria. The researchers also measured blood pressure levels in this group.

After eight years, the researchers evaluated these children again for sleep apnea and high blood pressure. At this point, the participants were on average 16 years old (ages 12 to 23 years).

The researchers found that children whose sleep apnea continued into adolescence were nearly three times more likely to develop high blood pressure compared to those who never had sleep apnea. Those whose sleep apnea began as teenagers and met adult diagnostic criteria were nearly twice as likely to develop high blood pressure than those without sleep apnea. In addition, these teens were also more likely to have a specific form of high blood pressure called orthostatic hypertension, which occurs when standing up rapidly from a prone position and is considered a strong risk factor for heart disease in adulthood.

The exact biological mechanisms underlying the link between childhood sleep apnea and elevated blood pressure in adolescence are unclear. Obesity is a driving factor of sleep apnea even in the young, the researchers said.  Growing evidence also suggests that increased inflammation, oxidative stress, and impaired heart function caused by changes in the sympathetic nervous system may be at play, given the independent contribution of sleep apnea to high blood pressure and orthostatic hypertension observed, they added.

Like adult sleep apnea, pediatric sleep apnea can be treated. For some specific cases, surgical removal of the tonsils and adenoids can help. Other cases may require the use of a CPAP machine (continuous positive airway pressure), a device that delivers air through a mask to keep the airway open when worn during sleep. For children with obesity, adopting a healthy eating and exercise plan that leads to weight loss can also help. Fernandez-Mendoza encourages parents to talk to their child’s pediatrician if they suspect sleep apnea and encourages clinicians to integrate behavioral weight loss in their management of overweight youth with sleep apnea.

Fernandez-Mendoza is currently conducting another follow-up study of these youth, now aged 20 to 31 years old, to better understand the long-term impact of childhood sleep apnea on cardiovascular health in adulthood. 

Prototype app for mobile devices could screen children at risk for autism spectrum disorder

The findings suggest that the app could one day screen infants and toddlers for ASD and refer them for early intervention, when chances for treatment success are greatest.

The study appears in JAMA Pediatrics and was conducted by Geraldine Dawson, Ph.D., director of the NIH Autism Center of Excellence at Duke University, and colleagues. Funding was provided by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and National Institute of Mental Health.

Studies have found that the human brain is hard-wired for social cues, with a person’s gaze automatically focusing on social signals. In ASD, attention to social stimuli is reduced, and researchers have sought to screen for ASD in young children by tracking their eye movements while they view social stimuli. However, equipment used for visual tracking is expensive and requires specially trained personnel, limiting its use outside of laboratory settings.

The current study enrolled 933 toddlers ages 16 to 38 months during a well-child primary care visit. Of these children, 40 were later diagnosed with ASD. They viewed on a mobile device short videos of people smiling and making eye contact or engaging in conversation. Researchers recorded the children’s gaze patterns with the device’s camera and measured them using computer vision and machine learning analysis. Children with ASD were much less likely than typically developing children to focus on social cues and visually track the conversations in the videos.

Pending confirmation by larger studies, the authors concluded that this eye-tracking app featuring specially designed videos and computer vision analysis could be a viable method for identifying young children with ASD.

Orange SL & amp; Others finance medical evacuation of 5yr-old rape survivor

By Ahmad Sahid Nasralla

The Asmaa James Foundation (AJF) has been able to fundraise for the medical evacuation and treatment of a 5-year-old rape survivor previously at Aberdeen Women’s Center and Emergency Hospital.

Hope for little Angela

In February 2018, Angela (not her real name) was brutally raped by her 26-year-old uncle. This caused severe damage to her spine. Angela was admitted to the Aberdeen Women’s Center. Her situation further deteriorated recently when she suffered a bone fracture during physiotherapy.

The AJF in partnership with Legal Access for Women Yearning for Equal Rights (LAWYERS) have been working assiduously to raise funds for Angela’s medical care.

Max Smart Super Specialty Hospital in India through the Sick Pikin Foundation has agreed to examine Angela with the possibility of performing surgery to improve her health.

Mobile telecommunications company Orange Sierra Leone donated SLL 70,000,000 towards Angela’s medical care.

In addition, the AJF received donations from companies and well-meaning Sierra Leoneans at home and abroad, including Pee Cee & Sons and Milla Group who donated $5,000, Mrs. Basita Micheal and Ms. Jasmine Roberts donated $2,000 and $700 respectively.

“We are extremely touched by the generosity of Orange Sierra Leone and others who have contributed to help ease Angela’s pain,” said Asmaa James, Founder and President, AJF.

 “On behalf of the AJF and its partners, I want to thank the Aberdeen Women’s Center and the Medical Emergency Surgical Hospital for their support to Angela over this year. I also want to thank Mr. Ishmeal Charles and the Sick Pikin Foundation for facilitating and travelling with her to India.”

Angela has arrived in India in the care of Mr. Charles and a member of her family. The AJF will continue to push for the protection and care of Sierra Leone’s girls and women against all forms of sexual violence.