Cough Medicine, Younger Siblings, Residency Training – PediaCast 343

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Description

• Join Dr Mike in the PediaCast Studio for more News Parents (and Providers) Can Use! This week we cover Zika Virus and Microcephaly (with a research update!), allergy risk based on season of birth, hearing loss and nutritional supplements, cough and cold medications, younger siblings & obesity, the sugar content of fruit drinks, and helping young doctors become better parents.

Topics

• Zika Virus & Microcephaly
• Birth Season & Allergy Risk
• Hearing Loss & Nutritional Supplements
• Cough & Cold Medication
• Younger Siblings & Obesity
• Sugar Content of Fruit Drinks
• Helping Young Doctors Become Better Parents

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 on Columbus, Ohio.

It is Episode 343. Yes, we’ve had 343 shows. It’s April 13th, 2016. We’re calling this one “Cough Medicine, Younger Siblings, and Residency Training”.

Yeah, we’re talking about resident physicians. So learning how to become a doctor. Nah, you’re already a doctor, you graduated from medical school. You’re a resident and you’re learning your craft in whatever primary care field or specialty field that you choose. So that’s what we’re going to talk a little about, residency training. And in particular, when residents are also parents. So it will be kind of interesting.

It’s a special edition of PediaCast for you this week. We’re bursting at the seams with pediatric news, because there’s been a lot of really cool things in the pediatric literature recently that have practical application for lots of moms and dads out there, and I can only whittle them down so much. So this week, we’re going to take a break from interviews and listener questions and give you a full dose of pediatric and parenting news right here on the show.

Stories that have the potential for making a difference in the lives of your kids and family, so it’s important stuff in other words. So never fear, we have plenty of interviews coming soon, including poison prevention around the home, the management of cuts and scrapes, dental care and cavity prevention and providing for the spiritual needs of hospitalized kids and their families through pastoral care. So lots of great content on the interview front coming your way very soon.

The Ohio Chapter of the American Academy of Pediatrics is also going to be making another visit soon. So we’re excited. They have a mobile app that will help parents, so we’re going to talk about that.

0:02:29

And then, over on the PediaCast CME front, PediaCast CME.org — that’s our show for pediatric providers — we offer free Continuing Medical Education Credit for them. We’re going to be covering Type 2 diabetes. Actually, we just covered that one. So that’s the most recent show over there at that site.

And then, coming up soon, we’re going to talk about hypertension, or high blood pressure, also mentoring relationships. So older, more mature, more experienced physicians mentoring their younger colleagues, we’re going to talk about that. And also taking the heat, dealing with emotionally charged interactions in the examination room. Those last two will be for faculty development credit. What that means is we’re just helping doctors become better doctors through the art of practicing medicine.

So that’s all coming your way over PediaCast CME. So lots on the horizon on both PediaCast and PediaCast CME, plenty of opportunity to answer more of your questions. I’ll fill you in on how you can get those questions to me. Or if you have a topic suggestion, that’s great. Or if you have a particular pediatric or parenting question you want to throw my way, and I’ll explain how you can do that in just a couple of minutes.

First, let’s explore the line-up. We do have some interesting stuff today for you. We have a Zika virus update. Researchers are working like crazy, trying to get a handle on the situation in South America and the Caribbean. So you can expect a lot of fresh research coming down the pike as we try to quantify the risk and make evidence-based recommendations because we’re just learning this stuff as we proceed.

And we have one of the first studies published on the Zika virus. It’s one that takes a look at a previous outbreak, and it attempts to nail down when during pregnancy that exposure is dangerous as it relates to Zika and the occurrence of microcephaly. And it also attempts to put a number on that risk.

0:04:27

So if you’re exposed to Zika virus during pregnancy, during a particular high risk period of the pregnancy, well, first, what period of pregnancy is most high risk? And then, what’s the chance that your baby will actually have microcephaly?

So this study attempts to answer those questions based on a previous outbreak, yes. But it’s a number that’s of interest for the current outbreak as well. So we’ll explore this updated information in this brand new research study that’s out concerning Zika virus and microcephaly.

And then, we’re going to talk about birth season and allergies. Now, this is a really interesting study. The time of year a child is born affects the likelihood of allergic disease later in life. Even much later in life including the occurrence of eczema and asthma. Now, traditional thinking would say this is because of allergen exposure to the baby.

So season kind of determines what allergens the baby’s exposed to, which in turn affects the immune system. And that may be true to some degree but it also appears that the season in which a baby is born affects the DNA in a way that can transmitted to the next generation. So the time of year your baby is born might not only affect allergies later in life for that baby, but also in that baby’s offspring.

So this will be a crazy concept for many of you. We’ll explore the science of it, which is interesting. Actually, fascinating in my view, but then again, I’m a pediatrician. What do you expect?

We’ll try to put a practical spin on it because knowing which seasons are worst may affect pregnancy timing and family planning at least to the degree to which these things can be planned. So we’ll talk through that as well.

0:06:15

And then, hearing loss and nutritional supplements. Certain vitamins and minerals, can they prevent hearing loss? Can they cause hearing loss and maybe both? So we’ll consider those questions. Cough and cold medications, I know we’re sort of heading out of cold and flu season at this point, not into it. But there is a new study out there that looks into how many parents are still giving young kids cough and cold medicines.
Since there are plenty studies already out there, showing that number one, they don’t work. And number two, cough and cold medicines are dangerous for young children, if parents are still giving them to young children, despite the fact that they don’t work and they’re dangerous, how can we make more parents aware of these facts, of the lack of benefits and the potential danger? It’s an important topic really regardless of the time of year because the health of our children’s at stake when we don’t talk about it, especially in light of the apparent lack of awareness that’s out there. So we’ll open that can of worms and explain.

Then, we’re going to talk about the effect of younger siblings on a child’s health. It turns out it’s good to have a younger sibling. We’ll explain why and share the age spacing that appears to be best.

Then, we’re going to have a warning on fruit juices. They don’t count as a serving of fruit and too much can be harmful for teeth and weight. So how much is too much? And did you know that many fruit drinks that are out there, the manufacturers actually add sugar to the juice? So we’ll explore what to look for on the nutrition label and tell you a little bit more about the dangers of fruit juices.

And finally, parenting during medical residency training. We have lots of parents in the audience. We also have pediatric providers and pediatric learners. And we have some audience members who are pediatric learners and also parents. So that would be specifically pediatric residents who are learning the craft of practicing pediatrics. But they’re also parents or soon-to-be parents.

0:08:21

So this story will be for them, kind of that intersection of being a provider and a parent. So being in the audience and actually belonging to both of those groups. And we’re going to take a look into the study that considers best ways to support resident physicians who also happen to be parents.

So, as I said, lots of pediatric news coming your way today. I couldn’t whittle it down to three stories this week, like I’ve been doing. It’s all good and practical stuff. So we’ll just put a temporary hold on the interviews and answering your questions, but not for long.

So if you do have a question for me, please ask away. It’s really easy to get in touch. Just head over to PediaCast.org, click on the Contact link and submit your question that way. I do read each and every comment and question that comes through, and we’ll try to get your question on the show.

We also have a voice line, if you’d like to leave your message or your comment that way. You can do it on Skype, you can use your mobile phone. Just call 347-404-KIDS, 347-404-5437. Just leave a message that way and we’ll try to get your question on the program.

Also, I want to remind you that the information presented in every episode of this program, it’s for general educational purposes only. We don’t practice medicine here. We do not diagnose medical conditions. We don’t formulate treatment plans for specific individuals. But we can talk about topics in general and provide general education and information for you.

So, if you do have a concern about your particular child’s health, make sure you call your 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 PediaCast.org.

Let’s take a quick break and I will be back with news parents can use. Lots of it, in fact. That’s coming up, right after this.

0:10:10

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Dr. Mike Patrick: We’ve covered Zika virus and its association with microcephaly and Guillain-Barre Syndrome several times here on PediaCast. And I promised that we’d update the information and cover new developments as they became available.

In keeping with that promise, I do have an update for you today. We’ve said all along that the uptick in babies born with microcephaly, which means they’re born with small heads and underdeveloped brains — and that results in all sorts of developmental problems and even the possibility of death — we’ve said that this uptick in babies born with microcephaly, particularly in Brazil and Columbia, is occurring at the same time as widespread Zika virus infection.

What we didn’t know for sure, was is this relationship casual, meaning, they just happen to be occurring together or is it causal meaning Zika is causing the observed uptick in cases of microcephaly. We had the feeling the relationship was causal because Zika virus had been found in the brains of affected babies. Although that still doesn’t prove cause, it was certainly enough of a smoking gun to educate the public and issue travel warnings.

In the meantime, scientists and research teams had been looking into the relationship between Zika virus and microcephaly trying their best to gain lots of understanding in a very short amount of time. And one of the places they’re looking is a previously known Zika virus outbreak in French Polynesia between 2013 and 2014. Because if they found an uptick in microcephaly and that outbreak, it would lend credibility to the idea that Zika is the cause rather an innocent bystander.

0:12:20

Well, as it turns out, there was an uptick in babies born with microcephaly in French Polynesia from 2013 to 2014 during the Zika virus outbreak in that region of the world. And we have data on occurrence rates from that outbreak which may help us predict the impact of the current Zika virus outbreak in South America and parts of the Caribbean.

The study, recently published in the journal Lancet, estimates the risk of microcephaly at about one case in every 100 women infected with the Zika virus during the first trimester of pregnancy.

So about 1% of babies born to moms infected with Zika virus during the first trimester of pregnancy were born with microcephaly in French Polynesia between 2013 and 2014.

The authors say that quantifying this risk better informs the broader public health response. Although the risk of microcephaly associated with Zika virus infection is relatively low compared to other maternal infections, the authors say that the association remains an important public health issue because the risk of Zika virus infection is particularly high during outbreaks, such as the one currently happening in South America.

Dr. Simon Cauchemez — co-author of the report and scientist at the Institute Pasteur in Paris, France — clarifies the meaning of the numbers by saying, “Our analysis strongly supports the hypothesis that Zika virus infection during the first trimester of pregnancy is associated with an increased risk of microcephaly. We estimated that the risk of microcephaly was 1 in 100 women infected with Zika virus during the first trimester of pregnancy. The findings are from the 2013 to 2014 outbreak in French Polynesia and it remains to be seen whether our findings apply to other countries in the same way.”

0:14:15

So what’s the baseline incidence of microcephaly at times when there is not an outbreak of Zika virus? That’s an important number to consider and to compare that 1% number, too. Well, in Europe and Brazil, the baseline occurrence of microcephaly is about 2 cases in every 10,000 babies which is an incidence rate of 0.02% compared to the 1% rate seen in mothers infected with Zika virus during their first trimester in the 2013 to 2014 French Polynesia outbreak.

Babies born with microcephaly have abnormally small heads, and the condition is associated with a reduction in brain volume, often leading to severe intellectual disabilities, speech impairment and behavioral issues. Causes include genetic and environmental factors, including prenatal viral infections, such as rubella or herpes and as it’s becoming more apparent, Zika virus. Maternal alcohol use and hypertensive disorders are other known causes of microcephaly in neonates.

Although evidence of the association between microcephaly and Zika virus is growing, until now, the risk had not been quantified. The outbreak in French Polynesia began in October 2013, peaked in December 2013 and ended in April 2014. Over that time period, more than 31,000 people saw their doctor with suspected Zika virus infection.

Researchers undertook significant detective work using mathematical and statistical models to estimate the expected number of microcephaly cases under different assumptions about the risk of microcephaly from Zika virus infection. Now, remember, during the French Polynesia outbreak, the association between Zika and microcephaly had not been identified and was not really considered. Pregnant women weren’t getting tested for Zika and the babies born with microcephaly weren’t tested for it.

0:16:12

So how did researchers arrived at their conclusion? Well, here’s where things get really interesting. They compared models where the risk was highest during different trimesters of pregnancy and a model where there was no association at all. Researchers then use data on the total number of cases of microcephaly, the weekly number of consultations for suspected Zika virus infection, blood tests confirming the presence of Zika virus antibodies taken after the outbreak, and the total number of births during the outbreak.

By comparing these models to the numbers and timing of actual cases of microcephaly, they found that the scenario where the first trimester of pregnancy was associated with an increased risk was most consistent with the observed data. At this point, researchers were able to estimate the risk of microcephaly as 95 in 10,000 women or approximately 1 in a 100 infected with Zika virus during that first trimester of pregnancy.

Dr. Arnaud Fontanet, another co-author of the study and also from the Institute Pasteur says, “Data from French Polynesia are particularly important since the outbreak is already over. This provides us with a small, yet much more complete dataset than data gathered from an ongoing outbreak. Much more research is needed to understand how Zika might cause microcephaly. Our findings support the World Health Organization’s recommendations for pregnant women to protect themselves from mosquito bites.”

Writing in a linked Comment, Dr. Laura Rodrigues, with the London School of Hygiene & Tropical Medicine in the United Kingdom, says, “The findings that the highest risk of microcephaly was associated with infection in the first trimester of pregnancy is biologically plausible, given the timing of brain development and the type and severity of observed neurological abnormalities.” She also highlights the need for more research saying, “Further data will soon be available from Colombia and Brazil, along with other sites and the fast production of knowledge during this epidemic is an opportunity to observe science in the making.”

0:18:15

I like the way she puts that, we are watching science in the making. That’s exactly what it is and why we’re covering it with such intensity here on PediaCast. It affects pregnant women and babies. So it’s definitely a pediatric issue. But I think the other thing is we really are witnessing scientific discoveries about this relationship as they occur. And as we learn more, stay tune to PediaCast for the latest updates.

Researchers at the University of South Hampton have discovered specific markers on DNA that linked the season of birth to risk of allergy in later life. The season in which a person is born in influences a wide range of things — from risk of allergic disease, to height and lifespan. Yet, little is known about how a one-time exposure like the season of birth has such lasting effects.

The Southampton study, recently published in the journal Allergy, conducted epigenetic scanning on DNA samples from a group of people born on the Isle of Wight. They found that particular epigenetic marks, specifically, DNA methylation, were associated with season of birth and still present on the DNA 18 years later. The research team then linked these birth season epigenetic marks to allergic disease. For example, people born in autumn had an increased risk of eczema compared to those born in the spring.

And just in case these finding were specific to the population on the Isle of Wight, researchers validated their findings in a large cohort of Dutch children.

Dr. John Holloway, professor of Allergy and Respiratory Genetics at the University of Southampton and one of the study’s authors, says, “These are really interesting results. We know that season of birth has an effect on people throughout their lives. For example, people born in autumn and winter are at increased risk of allergic diseases such as asthma. However, until now, we did not know how the effects could be so long lasting.

0:20:17

“Epigenetic marks are attached onto DNA, and can influence gene expression — the process by which specific genes are activated to produce a required protein. They have this effect for years, maybe even into the next generation. Our study has linked specific epigenetic marks with season of birth and risk of allergy. However, while these results have clinical implications in mediating against allergy risk, we are not advising altering pregnancy timing.”

Dr. Gabrielle Lockett, also from the University of Southampton and first author of the study, says, “It might sound like a horoscope by the seasons, but now we have scientific evidence for how that horoscope could work. Because season of birth influences so many things, the epigenetic marks discovered in this study could also potentially be the mechanism for other seasonally influenced diseases and traits too, not just allergy.”

The team say that further research is needed to understand what it is about the different seasons of the year that leads to altered disease risk, and whether specific differences in the seasons including temperature, sunlight levels and diet play a part. More study is also needed on the relationship between DNA methylation and allergic disease, and whether other environmental exposures also alter the epigenome, with potential disease implications.

So this is really amazing stuff here. If you would ask the question a few years ago, why do people born in autumn and winter have a higher incidence of eczema, and other allergic diseases, the answer would likely have been the hypothesis that specific allergen exposure during the autumn and winter months in these young babies triggers the immune system which mediates the observed allergic responses for years to come. And that hypothesis is probably still valid on some level.

0:22:08

But now, we’re learning about a different mechanism at a level of a DNA whereby external molecules cling to the DNA and alter the expression of specific genes. And the presence or absence of these molecules is dependent on the season in which one is born, and these modifying factors can be passed on to future generations.

So this is crazy amazing stuff and we’re just at the cusp of learning more about it. So definitely interesting days ahead in the world of genetic research, no doubt about that.

Healthcare providers and researchers are often accused of steering families away from so-called natural remedies. But the truth is, we’re interested in what works, not where it comes from. And if what works happens to come from a seemingly natural source, we’re fine with that, as long as there is evidence to back up the claim.

Enter research looking at the role of nutritional supplements in the treatment of hearing loss. Investigators have found an enhanced diet helps reduce hearing loss in mice with the genetic mutation most commonly responsible for human childhood deafness.

The study found that an antioxidant regimen of beta-carotene, which is a precursor to vitamin A, along with vitamins C and E and magnesium helps slow progression of hereditary deafness in the mice with a connexin 26 gene deletion. Mutations in this gene are a leading cause of genetic hearing loss in many populations.

Meanwhile — and this is important — the enhanced diet had the opposite effect on another mouse population with the genetic mutation AUNA1, which results in a different and rare type of hearing loss. In the case of AUNA1, the diet hastened deafness in affected mice.

All this is according to research from University of Michigan and CS Mott Children’s Hospital, recently published in the journal, Scientific Reports.

0:24:05

Dr. Glenn Green, associate professor of Pediatric Otolaryngology at CS Mott Children’s Hospital says, “Many babies born with a genetic mutation that causes deafness pass their newborn hearing screen but then go on to lose their hearing later in life. This pattern suggest that for some children, there may be opportunity to potentially save hearing cells present at birth. For these children, it’s crucial we identify therapies that prevent progression and possibly reverse hearing loss.

Dr. Yehoash Raphael, senior author of the paper and professor of Otolaryngology at the University of Michigan Medical School, says, “Our findings suggest that a particularly high dose of mineral and vitamin supplements may be beneficial to one particular genetic mutation. However, the negative outcome in the AUNA1 mouse model suggests that different mutations may respond to the special diet in different ways.”

Mice in the study received the antioxidant regimen while in the uterus and after birth in separate experiments. In the connexin 26 mouse model, the enhanced diet was associated with a slower progression of hearing loss and a small but significant improvement in hearing thresholds. However, mice with the AUNA1 gene mutation experienced the opposite outcome, showing accelerated progression of deafness following the diet.

Dr. Josef Miller, another of the study’s authors and developer of the micronutrient formulation, says in the inner ear, reducing oxidative stress related to overstimulation has been shown to protect sensory hair cells and hearing. Anti-oxidants have been shown to reduce the impact of oxidative stress in the renal disorder, cancer, heart disease and inflammatory disease. Antioxidant treatment has also been shown to preserve gap junctions, which are the cellular components directly impacted by loss of connexin 26.

Dr. Green adds, “These findings are encouraging for those of us who treat children with progressive connexin 26 hearing loss, and possibly for other mutations not yet tested. However, further studies are needed to confirm these findings in human children and to explore whether oral administration of antioxidants could someday be considered as an effective treatment.”

0:26:20

This research follows a case study from the University of Michigan published last year in which the same nutritional supplements were associated with slowing the progression of deafness for a boy with a connexin 26 mutation.

So betacarotene, vitamin C and E, along with magnesium, they may prevent hearing loss for some but hasten it for others depending on specific genetic mutations associated with a particular person’s hearing disease. Obviously, that’s something you want to do on your own, but certainly words of encouragement for many parents with children affected by these disorders and proof I think that clinicians and researchers are all four so-called natural remedies, when these remedies are shown to work without causing harm.

The following news story comes from my medical colleagues in Canada. So that’s where the numbers and observations originate but, it’s an important story for parents and providers in the United States as well as other countries around the world.

It’s also a story that pertains more to the winter months, I’ll give you that and here we are in the midst of spring in the United States. But really it’s an important story anytime of the year. It’s one that’s newly released and hey, folks will come across it anytime they search PediaCast and cough medicine or in case moms and dads are interested on my take on giving it to kids in the months and years to come.

Okay, I think I’d adequately justified including this news story. At least, I’ve convinced myself. So let’s get to it.

A new study, recently published in the Canadian Journal of Public Health finds that about 18% of children still received cough and cold medications despite label warnings advising against their use in children under the age of six years.

That’s down from 22% before the introduction of Health Canada’s labeling requirement in 2009. So before the warning label, 22% of young kids were given cough medicines and cold medicines, and it only dropped from 22% to 18%. Not a very big drop after the warning labels were applied in 2009.

0:28:25

Dr. Jonathon Maguire, lead researcher and pediatrician with St. Michael’s Hospital says, “We found that a large number of young children continue to receive over-the-counter cough and cold medications even with evidence of harm, public health advisories from government agencies and mandated labeling requirements for the manufacturers. In addition, evidence continues to suggest that these medications are not effective in young children and they represent documented risk, which means stronger measures may be needed to curtail their use.”

In 2009, Health Canada mandated warnings on cough and cold medications advising against use in children under six based on lack of evidence on their effectiveness and reports of harm and risk of adverse events. Researchers say the labeling standard has had a small effect on lowering their use on young children and the proportion of children regularly receiving them, nearly one in five is still quite high.

Dr. Maguire says, “I think a lot of parents would be surprised to learn that these medications can be harmful to children. Better public awareness as well as making these readily available medications harder to purchase may help reduce their use.”

He adds that other potentially harmful substances such as tobacco products have seen a decrease in use by warning labels and placing the substance behind-the-counter. He believes a similar dual strategy may be needed to further reduce cough and cold medication use in young children.

The study also found that children with younger parents and those with older siblings were more likely to receive cough and cold medications, suggesting a need for increased education within these groups.

0:30:06

Dr. Maguire says, “Young parents and those who used these medications with older children prior to the Health Canada warning may not be aware of the danger or the change, so it’s important for health professionals to raise awareness.” He admits, when a child has a cough or cold, it’s extremely challenging for families and parents who are looking for some relief.

He advises patience along with a lots of hugs and kisses, saying coughs and colds get better with time.

The researchers asked parents of 3,500 children under the age of six about their use of cough and cold medications . These families were participating in TARGet Kids!, a unique collaboration between pediatricians and researchers from St. Michael’s Hospital and The Hospital for Sick Children in Toronto. The program follows children from birth with the aim of understanding and preventing common problems in the early years to minimize their impact on health and disease later in life.

So, a few important points from this story. First, you should know that cough and cold medication pose a danger for children less than six years of age. Kids can and do die from their use. So there’s that. Second, cough and cold medications don’t really reduce cough and cold symptoms in young children. They make them drowsy. They help them sleep, yes. But an over-drowsy kid with a mucus blocked airway is not a good combination. It’s recipe for airway obstruction, aspiration and the development of pneumonia.

Remember, mucus and coughing are actually good things. Mucus traps microorganisms and coughing keeps them out of the lungs. So nasal congestion and coughing are important protective mechanisms. That’s an important point to keep in mind.

Yes, cough and cold symptoms are annoying for the kid who has them and the rest of their family, but they’re not really dangerous. On the other hand, cough and cold medications are dangerous for young kids.

0:32:01

Okay, so what can you do? Well, here I differ from the study authors a little bit. I don’t think patients and hugs and kisses are the only answer. In fact, there may be good reason to avoid too much hugging and kissing with a mucus soaked toddler, if you know what I’m saying. Comfort them, yes, but maybe more so at arm’s length which you can still do with much love and reassurance.

You also want to help them clear their nasal passages of all that mucus that will help them breathe more easily while still allowing room for the protective mechanisms to work. Humidifier in the bedroom helps loosen mucus, as does saline and salt water nose drop and sucking out the nasal passages, either with a bulb syringe or one of those fancy dancy filtered mum suckers. You know the kind I’m talking about, the one that dads are not as inclined to use, where you stick one into the tubing in the child’s nose and you suck on the other end hopefully through a filter. You could try those.

Older kids should learn how to effectively blow their nose at the earliest age possible. Children over the age of 12 months can have a spoonful of honey which may soothe the throat and reduce cough without stuffing it completely. That’s one of my favorite remedies when dealing with my own cough or cold.

So the take-home of this story, in case you didn’t catch it, regardless of the time of year, cough and cold medications don’t work for children under the age of six. They probably don’t really work so well for older kids and adults either, and they may in fact cause harm.

So please take this message to heart and help us spread the word.

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0:34:06

Dr. Mike Patrick: Becoming a big brother or a big sister before first grade may lower a child’s risk of becoming obese. This according to a new study recently published in the journal, Pediatrics.

The birth of a sibling, especially when the child is between two and four years of age is associated with a healthier body mass index or BMI by the time these kids are in the first grade. Children the same age who do not have a younger sibling are nearly three times more likely to be obese by the first grade.

Investigators studied 697 families across the United States. Dr. Julie Lumeng, senior author of the study and a developmental and behavioral pediatrician at CS Mott Children’s Hospital, says, “Our research suggests having younger siblings, compared with having older siblings or no siblings, is associated with a lower risk of being overweight. However, we have very little information about how the birth of a sibling may shape obesity risk later in childhood.”

She adds, “The study is believed to be the first to track subsequent increases in BMI after a child becomes a big brother or a big sister.”

So why is this observation seen? Well, the authors speculate that one possible explanation could be that parents may change the way they feed their child once a new sibling is born. With children developing long-lasting eating habits at around three years of age, changing dietary habits around this time may have a significant and long-lasting impact. Investigators also note that children may engage in more ‘active play’ or less sedentary time in front of screens once a younger sibling is born, further contributing to healthier BMIs.

Dr. Lumeng says, “We need to further study how having a sibling may impact even subtle changes such as mealtime behaviors and physical activity. Childhood obesity rates continue to be a cause of great concern if the birth of a sibling changes behaviors within a family in ways that protect against obesity. Then, these may be patterns other families can try to create in their own homes. By better understanding the potential connection between the sibling and weight, health providers and families create new strategies for helping children grow up healthy.”

0:36:21

So we’ve previously talked about pregnancy spacing on PediaCast, and we’d presented evidence that waiting at least 18 months following delivery to get pregnant again produces best outcome for mom and baby. So if you wait 18 months to get pregnant and your subsequent child goes to term, that would give you just over two years between children — which places your kids in the zone, covered by the study which found healthier BMIs in the older sibling when a younger brother or sister is born two to four years apart.

So we have another reason to wait at least 18 months to become pregnant again following the birth of a child. Interesting stuff and certainly practical for those of you concerned with family planning. Of course, you know what they say about the best-laid plans. They don’t always work out, and when they don’t — which happen to all of us from time to time in one arena or another — when our plans don’t work out, we have to pick ourselves up and go with the flow. Still it doesn’t hurt to have a plan and spacing kids two to four years apart sounds like a good one to me.

Researchers from the University of Liverpool and colleagues from Action on Sugar have assessed the sugar content of over 200 fruit drinks market at children and had found the sugar content of these drinks to be unacceptably high. Results of the survey were recently published in the journal, BMJ Open.

Investigators measured the amount of free sugars in over 200 brands of 100% natural juices and smoothies marketed specifically to children. They use the package label and compared standard portion sizes, which was 200 ml of each product.

0:38:05

So what exactly are free sugars? Well, these refer to glucose, fructose and sucrose or table sugar which are added by the manufacturer. And they also refer to naturally-occurring sugars in honey, syrups, fruit juices and fruit juice concentrates. But what don’t count as free sugars are the naturally occurring ones found in whole fruits and vegetables, which the body metabolizes differently and which act to curve energy intake.

The results highlighted wide variations in the amount of free sugars between different types of drinks and among different brands of the same product type. Almost half the products met or exceeded a child’s entire daily recommended maximum sugar intake of 19 grams or 5 teaspoons.

Dr. Simon Capewell, lead author of the paper and a professor at the University of Liverpool, says, “Increasing public awareness of the detrimental effect sugar sweetened drinks have had on kids’ teeth and waistlines has prompted many parents to opt for seemingly healthier fruit juice and smoothie alternatives. Unfortunately, our research shows that these parents have been misled. The sugar content of the fruit drinks, including natural fruit juices and smoothies is often unacceptably high and smoothies are among the worst offenders.”

Incidentally, nutrition labels on the juices and smoothies reveal that the amount of sugar is below the recommended daily maximum. However, these number apply to the average sized active adult woman and are inappropriate for children. As a result of the findings, researchers make several recommendations.

So here’s the practical part of the story for those of you keeping score. You should not count fruit juices, fruit drinks and smoothies as a serving of fruit. Fruit servings should be eaten whole, not drank as a juice.
Parents should dilute fruit juice with water or opt for unsweetened juices, and only serve these drinks during meals. Portion sizes should be limited to 150 ml/day, not the current 200.

Dr. Capewell also says, “Manufacturers should stop adding unnecessary amounts of sugars, and therefore calories, to their fruit drinks, juices and smoothie products. Our kids are being harmed for the sake of industry profits. If companies can’t slash sugar voluntarily, the government should step in with regulations.” That’s according to Dr. Capewell.

0:40:37

So this is a study from the United Kingdom. But a quick look at fruit juices and smoothie labels in US supermarkets and on the shelves here in the United States really reveal a similar problem. Lots of sugar in these products, which is why kids like them, right? They taste good. And as a parent, you think, “Hey, at least they’re drinking juice. They’re getting some fruit.”

Well, not so fast, drinking juice is not the same as eating whole fruit and fruit drinks and smoothies are contributing to our childhood obesity epidemic.

So take-home points from the story in case you missed them the first time around, they’re important — limit daily juice intake to no more than a 150ml which is just over 5 ounces. Serve the juice during meals not between them. And, if you want to serve more than five ounces, dilute the juice with water.

Speaking of water, that’s the ideal between-meal drink for most kids. Put a little splash of juice in the water, a twist of lemon for taste if necessary but use a very small amount, a splash of flavoring, not an ounce. And start these s suggestions as early as possible in your child’s life rather than waiting and making big changes when your kids are older. Much easier to follow these ideas from the get-go.

If you are making big changes for your older kids, make the changes together, even drink healthier as a family. Get active as a family. Be sure to do it together. Get creative, make it fun and support one another along the way.

0:42:08

We have plenty of pediatric and family practice resident physicians in the PediaCast audience listening as they learn. And this final news story of the week is dedicated to them, along with the training programs who are shaping their careers and directly impacting the current quality of their personal lives.

More and more physicians are becoming parents during their medical residency training. And while most residency training programs offer support for resident physicians during pregnancy, many fail to support resident physicians beyond the birth of their child, this according to a study from the University of Missouri School of Medicine and recently published in the journal Family Medicine.

Investigators say residency training programs need to be more supportive of new parents helping them manage the demanding work of their professional and personal lives.

Dr. Laura Morris, lead author of the paper and an assistant professor of Clinical, Family and Community Medicine at the University of Missouri School of Medicine says, “Residents with children are juggling multiple roles as medical trainees, physicians, partners and parents. Residency is a time of competing demands as trainees attempt to balance work roles such as being a learner and clinician with personal roles such as a partner and a parent. These conflicts can cause both positive and negative outcomes on the families and the residency experience.”

Dr. Morris and her colleagues conducted focus groups with family medicine residents who were also parents. Investigators asked the residents to discuss how parenting during residency had affected their well-being and how they perceive their roles as parents and physicians. Participants described both positive and negative outcomes from their decisions to become parents during residency.

The recurring theme was overwhelmingly support for greater scheduling flexibility at work.

0:44:00

Dr. Morris says, “Participants described negative residency experiences, such as being required to bounce back and forth between working days and nights, and the uncertainty of when and how to access sick leave. Participants also described feeling guilty for multiple reasons during residency, including not being able to offer more support to their spouse.”

Dr. Morris says her study highlights the need for more residency programs that support parents, and she believes residency programs should offer certain services to resident physicians to help ease their load.

She adds, “Residency programs that are supportive of physician parents should ensure their policies for parental leave are well publicized and equally applicable to male and female residents. In addition, these programs should explore the possibility of offering paid parental leave or on-site day care, as well as creating ways for residents to share parenting information and resources with each other.”

So there you have it. Many medical residents are parents too and they need support just like you.

[Laughter]

Dr. Mike Patrick: I feel a little like Dr. Seuss in saying that. However, it is an important point, and not only for the resident physician parent but also for the health and wellbeing of their partner, spouse or their child. Sometimes, the feeling in residency training programs is simply deal with it. You’re the one who chose to have a child at this point in your life. And that attitude is not healthy for the learner, for his or her family including the developing baby. So, organizations and programs who promote health need to promote it and support it with their learners, too, including resident physicians. That’s important.

I can also speak to this issue on a personal level because my wife and I had our first child nearly 22 years ago now, during the very first month of my residency training program. I know, poor planning, but you know, as I’ve said before, best laid plans and all, sometimes they just don’t work out.

In that, where I completed that residency training program where my daughter that very first month happened to be here at Nationwide Children’s Hospital. And I’m not just saying this because they happened to write my pay check these days. I truly felt supported along the way. I had time off right out of the gate, easier rotations at the front end of my residency while my daughter was really young those very first few months.

0:46:25

My wife now may have a different perspective because at the end of the day, there is a lot of time involved in learning the practice of medicine. So even those lighter months were still pretty busy. But I did feel well supported. At least, that’s how I remember it a couple of decades later, which may or may not be how I actually felt then. Just too long ago to remember for sure, if I’m being honest. But I don’t recall feeling unsupported. So I guess that’s good.

One really cool thing about having a baby during the first month of a pediatric residency, I didn’t have to memorize developmental milestones. I witness them as they happen, so that was pretty cool. And I can also speak from a platform of experience with the moms and dads of babies I was taking care of, so that was pretty cool, too.

At the end of the day, I wouldn’t change a thing, the timing, the experience of becoming a dad early on during residency training. Although I think becoming a mom would probably be more difficult, more challenges. I get that for a variety of reason.

Take-home point for the story, life goes on even during residency training, and organizations and program should do what they can to support not only professional development but that balance of work and life. I think it produces better more compassionate, more well-rounded doctors. I don’t have data supporting me in that notion but it sure makes sense. And common sense, when it’s anchored in experience and takes relevant evidence into account is important, too.

[Music]

0:48:26

Dr. Mike Patrick: All right, we are back with just enough time to thank all of you for taking time out of your day to make PediaCast a part of it. Really do appreciate that. I know I say that same thing week after week after week, but it’s true. I’m not just reading the words, I’m really feeling them from my heart. I really do appreciate this audience and all the support that you’ve given the program throughout the years. So I just want to thank you for participating and coming back show after show after show and making PediaCast a part of your day.

That is all the time we have. PediaCast is a production of Nationwide Children’s Hospital.

Don’t forget, you can find PediaCast in all sorts of places. We’re in iTunes, in the Kids and Family Section of their podcast directory. And, if you have not left us a review in iTunes, so if you are a regular user of iTunes, please consider leaving a review for us, because we actually haven’t had a new one in awhile. And a lot of people, when they’re looking for new shows, new podcast to listen to, they read those reviews in iTunes. So they can figure out, “Hey, is this a podcast that I want to invest my time in? Or is this going to be a waste of time?”

So I would ask, even if you’re have something critical to say, that’s fine too. But I would appreciate your reviews in iTunes, if you do have the opportunity to do so.

We’re also in most podcast apps for iOS and Android. If you can’t find us in your favorite podcast app, let me know and I’ll do my best to get the show added to their line-up.

We’re also on iHeart Radio, pretty proud of that. We not only have this program on iHeart Radio. We also have PediaBytes, B-Y-T-E-S, PediaBytes, all one word. They’re shorter clips from the show and you can weave them together with other content providers to create your own custom talk radio station.

And then, there’s the landing site, PediaCast.org. You’ll find hundreds of past episodes dating back to 2006, Show Notes, transcripts, our terms of use and, of course, a handy contact page to ask questions and suggest show topics.

0:50:30

We also have a voice line if you’d rather phone in your question or comment. That number is 347-404-KIDS. 347-404-K-I-D-S or 5437 if you need the digits.

We’re also on social media including Facebook, Twitter, Google+ and Pinterest with lots of great content you can share with your own online audience.

Of course, we always appreciate you talking us up with your family, friends, neighbors, co-workers, really anyone with kids or those who take care of children, including your child’s healthcare provider. In fact, next time you’re in for sick office visit — maybe it’s a well check-up, a sports physical, ADHD, medicine recheck — whatever the occasion, let them know you found an evidence-based pediatric podcast for moms and dads. We’ve been around for nearly a decade, so tons of content, deep enough to be helpful but hopefully in language parents can understand.

And while you have your providers’ ear, let them know we have a podcast for them as well. It’s PediaCast CME. That stands for Continuing Medical Education. It’s similar to this program, we turn up the science a couple of notches and provide free Category 1 Continuing Medical Education Credit for listening. Shows and details are available at PediaCastCME.org.

We also have posters if you like to share the show the old-fashioned way. Those are available under the Resources tab at PediaCast.org. Sometimes, the old-fashioned way is still really a good way. So if you print out a poster and hang up in your daycare center, bulletin boards at the office, at let’s say the Y community groups, your church, wherever, wherever it’s appropriate to put up a poster, we appreciate you helping us spread the word.

0:52:15

Thanks again for stopping by. Until next time, this is Dr. Mike, saying stay safe, stay healthy and stay involved with your kids. So long everybody.

[Music]

Announcer 2: This program is a production of Nationwide Children’s. Thanks for listening. We’ll see you next time on PediaCast.time on PediaCast.