Chefs, Sharenting, Medical Marijuana – PediaCast 314

Posted by Dr. Mike on April 8, 2015

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Show Notes

DESCRIPTION
Join Dr Mike in the Pediacast Studio for more News Parents Can Use. This week’s topics include the School Breakfast Program, chefs in school, diagnosing prematurity with a mobile app, sharenting (no, that’s not a typo), antipsychotic medication, and using medical marijuana for behavioral problems.

TOPICS
School Breakfast Program
Chefs in School
Diagnosing Prematurity with a Mobile App
Sharenting
Antipsychotic Medications
Medical Marijuana & Behavioral Problems

LINKS
Let’s Cook Healthy School Meals (Downloadable Cook Book)
Medical Marijuana: Review of the Science and Implications for Developmental-Behavioral Pediatrics

Transcription

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello everyone, and welcome once again to PediaCast. It's a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It is Episode 314 for April 8th, 2015. We're calling this one "The Chefs, Sharenting and Medical Marijuana".

I want to welcome everyone to the program.

We have more News Parents Can Use lined up for you this week, and I mentioned three of the topics in the title including Sharenting. And yes, you heard that right. It was not an accidental slurring of words. It was intentional.

Sharenting, what is it? Maybe you already know. I had not heard of sharenting before, so if you're like me and you need a definition and an explanation, I'll provide one, along with the rest of the lineup this week in a few moments.

First though, a quick reminder for the pediatric providers in the crowd — so we're talking about pediatricians, family practiced doctors, nurse practitioners, nurses and all varieties of students, even pharmacists, really, anyone who is medically involved and is a provider of medical care — I want you to know about PediaCast CME. We just launched, and you'll find it at PediaCastCME.org.

The new podcast, and it is brand new, folks. It's very similar to our nuts and bolts interview episodes on this program, but we rev up the science and offer free Category 1 Continuing Medical Education credits for our listeners.

0:02:05

It's really easy to participate just head over to PediaCastCME.org, sign up for a free account. Literally, it takes about two minutes to do this. You don't need an account to listen to the podcast. In fact, they're also available in iTunes and most podcasting apps for iPhone and Android. PediaCast CME is already in TuneIn and Stitcher, so you'll find it all over the place.

But if you want the free CME credit, you do need to sign up for an account, read through the Continuing Medical Education information sheet, listen to the podcast, take a quick post test, submit your answers, and if you score a 75% or higher on the test, we send you a Certificate of Participation for your records, and Nationwide Children's will add the activity to your CME transcript, which is important for those of us who are affiliated with a hospital.

However, affiliation with Nationwide Children's is not required. The podcasts and the Category 1 CME are free and available to everyone. All details are available at PediaCastCME.org, so be sure to check it out.

Our first two shows deal with medical education, so we have doctors teaching doctors and microteaching in medical education. Microteaching is an intentional system of making the most of that five-minute clinical presentation by resident or student on rounds or in your office. How do you make you five minutes really count?

We also have an episode on medical marijuana in the works, a very popular topic these days, but what does the evidence say about indications, benefits and risks in the pediatric population? You probably notice medical marijuana is in the lineup for this show today and we're going to talk about it in the context of behavioral problems, but over on PediaCastCME.org, we're going on a much more detail when that episode goes live later this month.

0:04:01

So, what else are we talking about today? Well, meals at school, we actually have two stories for you this week on school food. One, on the School Breakfast Program, which provides free breakfast for students, turns out that free breakfast is associated with better academics. So we'll talk about that.

And then, move over lunch ladies, some schools are hiring professional chefs to help plan and execute healthy and good tasting meals, but does this practice result in more kids eating fruits and vegetables? Or is it a waste of resources? We'll take a look.

And then, diagnosing prematurity with a mobile app. Now, I know, why is a mobile app needed for this? Don't most of mothers know their due date? And isn't the gestational age of a baby confirmed with ultrasound? Well, yes, unless you live in a developing country with no prenatal care, no ultrasounds and high mortality rates for babies who aren't identified as premature.

OK, so how will the mobile app help? Also, if ultrasound isn't available, would there be access to a Smartphone? And who would do what with that information? Well, stay tuned to find out.

And then, sharenting, it's not, I repeat, not shared parenting, which one I first heard the term, I thought that's what it might be. It's a common situation these days, but instead sharenting is sharing our victories and our trials and tribulations of parenting on social media.

So, you've seen the pictures and the videos. You've read the stories on Facebook and mommy blogs. But when are we crossing a line? Where does our need for community and support begin to invade our children's right to privacy? So we'll consider that question.

Then, antipsychotic medications, this class of drugs includes names like Risperdal, Seroquel, Abilify. Traditionally, this class of medications was used to treat diseases like schizophrenia, which is why they're called antipsychotics, but more and more in kids, they're being used to treat aggression and oppositional defiant behavior. What are the benefits of these drugs and the risks? When should they be used? Who should be using them? That's coming up.

Then, finally using medical marijuana for the treatment of behavioral problems. Is that a good thing, or not so much? Stick around, and we'll see where the evidence lies.

0:6:21

Don't forget, PediaCast is your program. If there is a subject that you want me to talk about, if you have a question for me or if you want to direct us to a particular news article or a research article, or an article that's in a journal, it's easy to get in touch. Just head over to PediaCast.org and click on the Contact link.

We also have a voice line that's open now at 347-404-KIDS. That's 347-404-K-I-D-S or 5437 are those last four digits. You can call that number and leave a message, and we'll try to get your question or your comment on the show.

Also, I want to remind you the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So, if you do have a concern about your child's health, be sure to call you doctor and arrange a face-to-face interview and hands-on physical examination.

Also your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at the PediaCast.org.

All right, let's take a quick break, and I will be back with News Parents Can Use right after this.

[Music]

Dr. Mike Patrick: All right, we are back. A new study from the University of Iowa reinforces the connection between good nutrition and good grades, finding that free school breakfast helps students from low income families perform better academically.

The study finds students who attend schools that participate in the Department of Agriculture's School Breakfast Program have higher achievement scores in math, science, and reading than students in schools that don't participate.

0:8:22

Dr. David Frisvold, lead investigator and assistant professor of Economics in the Tippie College of Business says, "These results suggest that persistent exposure to relatively more nutritious breakfast offered through the subsidized breakfast program throughout elementary school can yield important gains in achievement.

The federal government started the school breakfast program for children from low income families in 1966. The program is administered in coordination with state governance, many of which require local school districts to offer subsidized breakfast if a certain percentage of their overall enrollment comes from families that meet income eligibility guidelines."

Dr. Frisvold conducted his study by examining academic performance from students in schools that are just below the threshold, and thus not required to offer free breakfasts, and those are just over it and thus do offer them.

He found the schools that offered free breakfasts showed significantly better academic performance than schools that did not. And the impact was cumulative, so the longer the school participated in the School Breakfast Program, the higher their achievement. Math scores were about 25% higher at participating schools during a student's elementary school tenure than would otherwise be expected. Reading and Science scores showed similar gains.

Dr. Frisvold says the study suggests subsidized school breakfasts are an effective tool to help elementary school students from low income families achieve more in school and to be better prepared for later life.

So, this is one of those studies that show an association between free breakfast at school and academic performance.

0:10:02

Now, it doesn't really demonstrate a cause-and-effect relationship. Maybe schools that participate in the School Breakfast Program qualify for other state programs. Or maybe students who eat free breakfast at school feel like the school cares about them and is invested in them, which results in the students taking academics more seriously.

Maybe these schools have tutoring programs that the other schools don't have and that just doesn't get teased out due to a sampling effect. Or maybe some of the schools just aren't as academically rigorous, and it's easier to succeed. Or maybe filling the brain day-in and day-out with nutritious breakfast really does boost academic performance.

And maybe the bottom line is the complex interaction of several or all of these possibilities. Still the association is there and it's a hard one to ignore because we've all heard that breakfast is the most important meal of the day. Maybe it is.

So, are your children eating a nutritious breakfast? And, does your school participate in the School Breakfast Program? If you don't know the answers to these questions, you may want to do some investigating of your own.

Speaking of meals at school, schools collaborating with a professionally trained chef to improve the taste of healthy meals significantly increase students' fruit and vegetable consumption. This, according to a new study lead by researchers at Harvard's T.H. Chan School of Public Health and published in the online version of JAMA Pediatrics.

The study also found that using "choice architecture" which represents environmental nudges to promote healthy choices in school cafeterias improved student's selection of fruits and vegetables but did not increase consumption over the long term. The study is the first to examine the long-lasting impact of choice architecture and chef-enhanced meals in school cafeterias on selection and consumption of healthier foods.

Juliana Cohen, lead author of the study and research fellow in the Department of Nutrition at Harvard Chan says, "The results highlight the importance of focusing on the palatability of school meals. Partnerships with chefs can lead to substantial improvements and the quality of school meals and can be an economically feasible option for schools."

0:12:10

"Additionally, the study shows that schools should not abandon healthier foods if they're initially met with resistance by the students."

Thirty-two million US students eat school meals every day, and for many low income students, up to half of their daily calories come from these meals. More than 15,000 U S schools have implemented choice architecture methods, which include techniques such as placing healthy options at the beginning of the buffet line or placing light milk in front of sugar-sweetened milk.

Researchers conducted a school-based randomized clinical trial during the 2011 to 2012 school year, including students in 14 elementary and middle schools in two urban, low-income school districts in Massachusetts. All told, the study looked at 2,638 students in Grades 3 through 8.

The schools were randomly assigned to one of four groups. Schools in Group 1 received weekly training in recipe design from a professionally trained chef. Group 2 were instructed in choice architecture techniques, referred to as a smart cafe. Group 3 have the input of chefs and choice architecture. And Group 4, which was the control group, received no interventions at all.

After three months of exposure to the chef-only intervention, students selected 8% more vegetables than students at the control schools. And after seven months, students in the chef-only intervention schools were 20% more likely to choose a fruit than students in the control schools and 30% more likely to choose a vegetable.

Furthermore, the consumption of fruits and vegetables — meaning how much of the selected items were actually eaten — increased by similar percentages.

OK, what about students attending schools with the smart cafe or choice architecture? Well after four months, these increased their vegetable selection over control students by about 17%, and their fruit selection increased by 3%, but actual consumption of these items didn't really improved.

Also, there was no significant change in selection or consumption of white milk over chocolate milk. The schools with combined smart cafe and chef intervention fared only modestly better than the schools with chefs alone.

0:14:20

Dr. Eric Rimm, senior author of the study and professor in the Department of Epidemiology and Nutrition at Harvard Chan says, "Our study was not testing whether a local celebrity chef was good for the school lunch program. Our goal was to have a chef who could work with the whole school district to train personnel and design more palatable recipes without increasing the cost of the meal. It was a great success and really illustrated that through persistence, school-aged children can learn to like healthy whole grains, fruits, and vegetables, especially if they taste good.

In the end, the quality and taste of the food was much more impactful on consumption than were the effects of choice architecture. Schools should therefore put more effort into improving the palatability of school meals for the biggest impact on student diets. Additionally, schools may want to consider policies that eliminate chocolate milk, as choice architecture was not an effective strategy to improve white milk selection.”

So there you go. Like many of us moms and dads out there, kids prefer healthy foods that taste good over those that aren't so palatable. And hiring a chef in your school district can improve upon the taste, and then healthy food choices follow suit.

Hey, maybe the chef can teach a cooking class or two while they're at it. And again, we're not talking about an expensive celebrity chef, OK? We are not talking about Gordon Ramsay here, just one who knows how to make healthy food palatable for kids.

By the way, many of the chef-enhanced recipes included in the study are included in a book called "Let's Cook Healthy School Meals", which is available for free download on the Internet. If you like to download a copy, then take a look. I'll include a link to it over at PediaCast.org, in the Show Notes for this episode, 314.

0:16:03

Researchers at the University of Nottingham are developing a mobile phone app that will identify babies born prematurely in the developing world. The technology will use distinctive features of the feet, face and ears of newborns to accurately estimate the gestational age of babies and to identify those who may need urgent medical care.

The project, which brings together experts from the University's Division of Child Health, Obstetrics and Gynecology, and the School of Computer Science, is supported with a $100,000 grant from the Bill & Melinda Gates Foundation.

Dr. Don Sharkey, Clinical Associate Professor of Neonatal Medicine at the University of Nottingham says, "This could be a potentially transformative technology for the developing world, where the majority of women do not benefit from prenatal services during pregnancy and where high risks of infection and illness means premature births are commonplace."

Dr. Michel Valstar, a computer scientist on the project adds, "We're talking about countries where new mothers have little or no access to medical facilities, yet remarkably where smartphone technology is ubiquitous. Our aim is to harness that technology to transform mobile phones into medical devices that can be easily used by someone without medical training."

The research project was one of 60 successful bids out of 1,700 applications worldwide for funding from the Gates Foundation's Grand Challenges Explorations Grant Program which funds individuals worldwide to explore ideas that can break the mold in how we solve persistent global health and developmental challenges.

In places like rural Africa or India, women rarely have access to the prenatal ultrasounds used by doctors to determine the gestational age of babies in Western countries, and traditional methods of estimating gestation based on measurement and birth weight are not always reliable.

This is a problem because having the ability to determine the gestational development of babies and the potential consequences of premature birth can help village elders and community leaders to decide whether they might simply need to offer guidance to the mother on special hygiene and the nutritional needs of their infant, or to determine the need for hospitalization, which is often hundreds of miles away.

0:18:22

More than one million babies worldwide die as a result of prematurity every year, the majority of whom are born in the developing world. Premature babies in continents like Africa or countries in Africa are often at greater risk of dying as a result of poor nutrition and infections.

The app combines simple measurements with elements of the Ballard test, which is used by experienced healthcare professionals to estimate gestation, and looks at developmental characteristics like skin lines on the foot, certain facial features and ear shapes.

The new app will use the mobile phone's camera to take images of the foot, face and ear of the baby and upload it to a huge database where it will compare these images with pictures of hundreds of other babies at various known gestational ages to find a 'match'.

As part of the 18-month project, computer scientist will analyze data from the images of babies in other to build the app. Then, the clinical team will collect the baseline comparable data by taking pictures of babies in the maternity and neonatal units at Nottingham University Hospital's NHS Trust .

The team also plans to explore the potential ethnic differences in gestational development between babies born in different parts of the world. Babies born in Africa or China may have different developmental characteristics compared to their western counterparts.

At the end of the project, if the team is able to demonstrate a successful prototype, they will have the opportunity to bid for a much larger package of funding from the Gates Foundation to develop the technology for use in the real world.

So this is an interesting story — using a mobile app to identify premature babies in underdeveloped countries by taking pictures of the babies and comparing those pictures to a database.

It reminds me of a story we covered back in PediaCast Episode 291 using facial recognition software to aid in the diagnosis of rare genetic disorders. Lots of possibilities on both fronts and it leads me to wonder what other mobile technologies will improve our heath in the future.

0:20:19

Some of social media's greatest stars aren't even old enough to tweet. Pictures of babies playing dress-up, having meltdowns and even in the bathtub adorn user walls on Facebook. Diaper-donning toddlers dance to the likes of Beyonce and Taylor Swift while racking up YouTube videos, and countless blogs share stories about everything from potty training to preschool struggles.

The term for parents sharing all of these experiences is "Sharenting" and a national poll on children's health from the University of Michigan and C.S. Mott Children's Hospital finds that this practice isn't going anywhere anytime soon.

In fact, more than half of mothers and one-third of fathers discuss child health and parenting issues on social media, and nearly three-quarters of parents say sharenting makes them feel less alone.

But how far is too far when it comes to crossing the boundaries between public and private life?

Dr. Sarah Clark, associate director of the poll and a research scientist in the Department of Pediatrics at the University of Michigan says, "By the time children are old enough to use social media themselves, many already have a digital identity created for them by their parents."

She adds, "Sharing the joys and challenges of parenthood and documenting children's lives publicly has become a social norm. So we wanted to better understand the benefits and cons of these experiences. On one hand, social media offers today's parents an outlet they find incredibly useful. On the other hand, some are concerned that oversharing may pose safety and privacy risks for their children."

When sharing parenting advice on social media, common topics include getting kids to sleep, nutrition and eating tips, discipline, daycare, pre-school and behavior problems. That's according to data from the poll which surveyed a national sample of parents with children from newborn through four years of age.

Nearly 70% of the parents said they use social media to get advice from other more experienced parents, and 62% said it helped them worry less.

However, parents also recognize potential pitfalls of sharing information about their children, with nearly two-thirds concerned someone would learn private information about their kids or share photos they had posted. More than half also worried that when older, their child may be embarrassed by what was shared.

0:22:41

Dr. Clark says, "These networks bring parents together in ways that weren't possible before, allowing them to commiserate, trade tips and advice, share pride from milestones, and reassure one another that they're not alone. However, there is potential for the line between sharing and oversharing to get blurred. Parents may share information that their children finds embarrassing or too personal when they are older, but once it's out there, it's hard to undo. The child won't have much control over where it ends up or who sees it."

Three-quarters of the surveyed parents also pointed to "oversharenting" by another parent including moms and dads who shared embarrassing stories, gave information that could identify a child's location or posted photos perceived as inappropriate.

Stories of sharenting gone wrong have been rampant in the news with one of the most extreme examples including the phenomenon called "digital kidnapping" which involves strangers stealing online photos and resharing them as if the children were their own.

In other cases, photos of children would become the target of cruel jokes and cyberbullying. Among the most notorious cases in recent years was that of a Facebook group that made fun of "ugly" babies.

Dr. Clark says, "Parents are responsible for their child's privacy and they need to be thoughtful about how much share on social media, so they can enjoy the benefits of camaraderie but also protect their children's privacy today and in the future.

0:24:03

So, sharenting, it's a new word for my vocabulary. It's word that makes sense, and it's a practice that makes sense in terms of connecting with other parents, sharing experiences and learning from others. But as with nearly all things good, there is a line between what's helpful and what's potentially harmful. So share away, there's lots of benefit in sharing, but keep that line in sight. Protect the privacy of your kids and keep your children safe because that's important, too.

More kids nationwide are taking medications designed to treat mental illnesses such as schizophrenia and bipolar disorder, and researchers at the University of Vermont want to know why.

Investigators there conducted a study to find out if doctors are prescribing the right medications at a proper time to the right kids. The study, which was published in the Journal of Pediatrics, is the first one to delve into the clinical decision-making process of physicians who prescribe these drugs.

Dr. David Rettew, lead author of the study and associate professor of Psychiatry and Pediatrics at the University of Vermont says, "There are risks associated with using these medications. At the same time, I think they've saved lives."

Many studies have pointed to increasing use of antipsychotic medications for pediatric patients. The Agency for Healthcare Research and Quality, which is the research arm of the US Department of Health and Human Services, found that treatment with antipsychotic drugs climbed 62% for children on Medicaid between 2002 and 2007, reaching a total of 2.4% of all these children.

Dr. Rettew says he — along with fellow members of a Vermont state task force that keeps watch on use of psychiatric medicines in young people — wanted to answer the question — "Is this a reasonable thing, or are these medications potentially being overused?"

From Medicaid claims data, the researchers sent a survey to the prescriber of every antipsychotic medication — most commonly Risperdal, Seroquel and Abilify — issued between July and October 2012; 147 physicians representing 647 patients returned their surveys.

0:26:11

The researchers then turned to two sources of guidelines for appropriate use of antipsychotic medicines: the best practices recommendations outlined by the American Academy of Child and Adolescent Psychiatry, also known as the AACAP; and clinical indications from the US Food and Drug Administration or FDA.

The AACAP guidelines say that kids who haven't been officially diagnosed with major mental illness such as schizophrenia but who present with other types of behavioral problems, such as aggression, eating disorders or oppositional defiant behavior — these kids should receive treatment with these antipsychotic drugs only after other medications or non-pharmacologic therapies have been tried.

Dr. Rettew says, "Part of our concern is that these medicines may be getting used too early in the treatment of certain conditions like oppositional behavior, ahead of strategies like behavioral therapy which could be tried first."

Results to the survey showed that in half of these cases, doctors veered from the guidelines. The primary misstep was the failure to obtain lab tests to monitor cholesterol and blood glucose levels before and after the patient begin taking the medication.

The AACAP recommends the lab work because the use of antipsychotics can lead to high cholesterol and diabetes. The study found less evidence to support concerns about doctors ordering the drugs when they weren't indicated. As it turned out, almost 92% of doctors prescribed the drugs under the proper circumstances.

Dr. Rettew says the physicians tried antipsychotics as secondary treatment, progression and mood instability. They did not prescribe them for low level problems such as helping kids fall asleep or controlling temper tantrums.

0:27:55

National prescription rates for these medicines in the pediatric population sharply rose between 2002 and 2007. Researchers say the use of antipsychotics in children in Vermont has actually fallen since 2009 by 45% for children ages 6 to 12 and by 27% for ages 13 to 17. Which, you know, I think that sort of goes along with just in the beginning, people were starting to use these medicines for maybe some of those low-level problems. But then, when we see what risks there are, and as we get more education out there for doctors, then fewer of them are prescribing them just willy-nilly, and the ones who are prescribing them are doing so more appropriately.

So, it does kind of makes sense that we saw that rise and now we're seeing the fall again.

Dr. Rettew and his team suggest four ideas that could assist doctors who prescribe the antipsychotics. They say number one, increase use of electronic medical records to remind doctors of the necessary blood work. So if you enter one of these medicines into the electronic medical record, you get a little tickler. It comes up with a pop-up maybe that says, "Hey, don't forget to order these lab tests." So that can be a useful to help doctors remember.

Number two, increase access to evidence-based behavioral and medical therapies that can help alleviate anxiety, depression and oppositional behavior.

Number three, better training and consultation for doctors who don't initially prescribe the medicine but are responsible for monitoring patients who are now taking it.

And four, improved access to medical information across multiple centers, so doctors who prescribe the medications know the history of prior treatment.

Doctor Rettew says, "I am not anti-antipsychotics. I just want to make sure they're used very carefully, and these findings could help us design a game plan for improving best-practice prescribing."

So the most important take-home here for parents in my mind, number one, if your child is taking an antipsychotic medication including drugs like Risperdal, Seroquel and Abilify — and I use the brand name just because those are the names that parents out there know — if your child is taking one of these antipsychotic medicines, make sure you are following up regularly with your child's doctor and that your doctor's monitoring your child's weight, BMI, blood pressure, lipids and blood glucose. Very important.