Caffeine And Poverty Effects On Small Children – PediaCast 081

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Announcer: This is PediaCast.

Dr. Mike Patrick: Bandwidth for PediaCast is provided by Nationwide Children's Hospital. For every child, for every reason.


Announcer: Welcome to PediaCast. A pediatric broadcast for parents, the News Edition. And now, direct from Birdhouse Studios, here is your host, Dr. Mike

Dr. Mike Patrick: Hello everyone and welcome to PediaCast. It is episode 81, for Thursday, November 15th, 2007. This is Dr. Mike coming to you from Birdhouse Studio. And of course, I'd like to welcome everyone at to the program. It is a News Edition. We haven't had one of those yet this week. And we are going to talk about caffeine, poverty, and math. That's all coming up.


First, I have to tell you, there wasn't a show yesterday. You probably figured that out. And that may become more of an issue as the winter cold season takes root here. I just had a terrible day in the office yesterday. They're quite later than normal and we had complicated kids, and our schedule was overbooked and over flowing, and by the time I got home, I just didn't have in me to do much of anything. So it just didn't happen. I'm thinking, during the winter if I get three or four shows out a week, I'm going to be quite happy with that. Maybe with a few five weeks shows out certainly in the spring, we'll go back to five for sure. We will see how it goes. But I'm just warning you, being a pediatrician is definitely there's a seasonal difference depending on the time of the year and workload.


I also want to update you, those of you who have listened to PediaCast for a very long time, know that, one of the things that my children do, sort of their extracurricular activity, their main one, it's not sports, you go to know that the, our family it's not sports. We're not very coordinated. But they're really into acting, which shouldn't surprise you. And my kids are both in productions right now. My daughter is in "High School Musical". She's in that, in Columbus, Ohio. And my son is playing Christopher Robin in a Pooh Production, "Winnie the Pooh" also in Downtown Columbus. And the both of them have December runs with their shows and they both have rehearsals going on. So, our family life right now is crazy. Pretty much it's Karen takes Nick to his rehearsal, while Katie does school work and then they have to drive a few blocks across downtown Columbus to Katie's rehearsal, while Nick does school. I get home and have whatever the rest of the family had that they eat very quickly before they had to leave. And I warm the left overs and then work on the show a little bit.


So, and then, we… I see the kids long enough to hug them and kiss them. They go to bed and then my wife and I have a little wine, just a little bit. And, well most nights, anyway, we… life is crazy right now, but once these productions are over, the end of December, then life will get a little bit easier again.

And I only mentioned it because I'm sure many, many, many of you have lives that are just as crazy as mine. And so we can all share that moment.

OK. So what are we talking about in this news edition, well caffeine for apnea of prematurity, a video educates preschoolers about fighting infections, the effects of poverty on young children, gesturing helps grade-schoolers solve math problems and gaps are found in the professional values of pediatricians.


Don't forget if there is a topic you would like us to discuss, or if you have a lead on a great news story or a fantastic interview, just let us know. Got and click on the Contact Link. You can also email me at Let us know where you're from. Or call the voice line at 347-404-KIDS. Don't forget the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health 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

And with that in mind, we will be back with News Parents Can Use right after this short break.




Our News Parents Can Use edition is brought to you in conjunction with news partner Medical News Today, the largest independent health and medical news website and you can visit them online at

Very premature babies who were given caffeine to regulate their breathing had a significantly lower incidence of disabilities at the age of two years. According to an international study led by researchers at McMaster University. Researchers studied more than 2,000 premature babies who are either treated with caffeine or given a placebo. The latest result of this large clinical trial appeared in the November 8th issue of "The New England Journal of Medicine".


Babies receiving the caffeine were less likely to develop cerebral palsy and cognitive delay. Caffeine and similar drugs have been used for more than 30 years to make the breathing of very premature babies more regular but without sufficient knowledge of the possible benefits and risks. The study involved infants who weigh between 500 and 1,250 grams at birth, and who were at risk for apnea, which is a fancy word for interrupted or extreme irregularity of breathing. And in the case of these kids, the apnea was due to prematurity. The ongoing study with colleagues in Canada, Australia, the United States, Europe and Israel, will continue to follow the children until they reach the age of five. The project was funded by the Canadian Institutes of Health Research and The National Health and Medical Research Council of Australia.


According to Dr. Barbara Schmitt, principal investigator of the project, "the latest result of the study showed that 46% of the infants receiving the placebo, died or survived with a neurodevelopmental disability. Among the babies receiving caffeine therapy, only 40% had an unfavorable outcome by the time they had reached the end of their second year of life. It definitely gives hope that parents " Dr. Schmitt concluded, "of all the drugs we used in the neonatal intensive care unit, caffeine is the first to have been shown conclusively to reduce long term disability in very preterm baby. Caffeine reduce the rates of cerebral palsy and cognitive delay. But have no significant effect on the rates of death, bilateral blindness, or severe hearing loss".

"This international study provide important follow up to earlier results reported by Dr. Schmitt and her colleagues and should have a major impact on the treatment and prevention of apnea in preterm infants." said Dr. Michael Kramer, Scientific Director of the Canadian Institute of Human Development.


The caffeine for apnea of prematurity project enrolled 2,006 premature infants who were born between October 1999 and October 2004 in nine countries. The research project was designed to address long standing concerns about possible adverse effects of caffeine therapy in preterm infants. All children will be reassessed at five years to obtain more precise information on their development as they approach school age. Apnea occurs in about 85% of infants who were born at less than 34 weeks gestation. For more than 30 years, therapies known as methylxanthines including caffeine have been used to reduce the frequency of apnea and the need for mechanical ventilation. However, it has remained uncertain whether the use of methylxanthines like caffeine, has any additional benefits or risks in premature infants. Earlier findings released last year by the same research team revealed that babies who received caffeine had a lower incidence of abnormal lung development in infants who were given a placebo.


Dr. Schmitt said, that "half of the beneficial treatment effect at two years of age, was explained by the fact, babies receiving caffeine therapy came off of ventilators sooner". “Ventilation is a double edge sword she said, while it is lifesaving, at the same time it causes injury, scarring the immature lung which is very susceptible to damage.” So, the bottom line, coffee is just not for moms and dads.

Pandemic influenza occurs with a new flu virus emerges and people have little or no immunity against it, and there is no vaccine. Nearly half of AVN Influenza cases in the world have been in children and there are precautions that can be taken to prevent the spread from person to person. The Alabama Department of Public Health is introducing a story book video to teach children infection control measures such as hand washing, covering coughs and sneezes, and staying home when sick. This is part of the effort to ensure that even the youngest Alabama citizen is aware of, planning for, and preparing for the possibility of pandemic influenza.


Alabama officials are sending a cartoon character DVD entitled "Minnie Mouse Learns Healthy Habits" to all Alabama child care centers state wide during the month of November. Plus coloring sheets and stickers accompany each video. The flu season right around the corner and the recent attentions given the staph infections, Minnie Mouse provides a very important information that will be helpful in reducing transmission of colds, flu and staph infections says Dr. Thomas Miller, Assistant State Health Officer for Personal and Community Health. Parents should ask their child's school or child care center, when those presentations are planned. Children are more likely than adults to spread germs, so the Alabama Department of Public Health has made a strong effort to educate them about infection control measures as early as possible.

Alabama is the first state to use an educational video created specifically for child care centers. The DVD premiered to preschool children at the Taylor Road Baptist Church Child Care Center in Montgomery following a program last spring in which officials send letters in pandemic influenza educational folders to all exempt and non-exempt child care providers in an effort to educate directors and staff about pandemic flu.


"We're excited that Alabama's children will have the opportunity to learn and practice good preventive methods from an early age", Dr. Miller added. That Alabama's child care centers have an important role to play in teaching young children. And this cartoon video will help kids and adult alike prevent transmission of bacteria and viruses to others.

I do have a couple of my own two cents to add on this one. Maybe there is a reason Alabama is the only state to do this, I mean what's the cost of producing a DVD with a cartoon characters made specifically for this project about hand washing. I mean, isn't that something you can do in person, in homes, and in day care centers? Do you really need a character DVD to teach kids to wash their hands? It's hand washing for crying out loud, all right.


Scientist have known for years that people living in poverty have poor health and short life spans than the most affluent. Now, Cornell University researchers have identified several key mechanisms in 13 year-olds anyway that may help explain how low socioeconomic status takes its toll on health. The first longitudinal study on the physiological effects of poverty in young children, the Cornell researchers report that the longer 13 year-olds have lived in poverty, the less efficient their bodies become in handling environmental demands. We think these mechanisms may be related to the fact that children who grow up in poverty have a steeper life trajectory of premature health problems than older children regardless of their socioeconomic status in adulthood said Gary Evans, Professor of Human Ecology at Cornell. His study is published in a November issue of "Psychological Science".


These muted responses of stress regulatory mechanisms which are part of the cardiovascular system, not only compromise the ability of the adolescence body to respond to such stressors as noise, poor housing and family turmoil, but also indicate they are suffering from more stress induced physiological strains on their organs and tissues compared to other young people, said Evans. People need to understand that not leveling the playing field when it comes to poverty cost everybody money, it's very costly to society that low income children end up being sick prematurely and die younger than other people. Many researchers over the years have shown that childhood poverty affects long term morbidity, just the frequency of illness and disease and mortality, which means death, yet no one knows why. The researchers assess the neuroendocrine and cardiovascular markers of stress regulatory systems by measuring overnight levels of a stress hormone called cortisol, and blood pressure reactivativity and recovery after an acute stressor, like being asked unexpectedly to do mental math problem.


In 217 low and middle income white adolescents, at age 9 and then again at age 13. All of the kids lived in rural areas of upstate New York. Researchers assessed cumulative physical and social risk exposure by measuring crowding, noise, and housing quality in conjunction with maternal and youth reports of family turmoil, youth separation from family, and exposure to violence. The study provides yet another piece of evidence that poverty and other chronic risk factors induce physiological changes that appeared to be related to long term health problems.

Are math problems bugging your kids? Well, tell them to talk back using their hands. Psychologist at the University of Chicago report that gesturing can help kids at new and correct problem strategies to their mathematical repertoires. What's more, when given later instructions, kids who told to gesture are more likely to succeed on math problems. A report on these findings appears on the November issue of "The Journal of the American Psychological Association".


Researchers at the University of Chicago conducted two studies with a total of 176 children in late 3rd and early 4th grade. Brother's and her colleagues randomly assigned the students to different manipulations. Told to gesture, told not to gesture, and not told anything either way which was the control group. All participants have been found to make mistakes in solving math problems. In the studies base line face, students have to solve six math problems such as 6+3+7=x+7 on a chalkboard and explained to an experimenter how they solved each problem. The researchers quoted the children's videotaped efforts analyzing gestures and utterances that conveyed problem solving strategies.


Children told to move their hands when explaining how they solved the problems were four times as likely as kids given no instructions to manually express correct new ways to solve problems. Even though they didn't in the end got the right answer, their gestures revealed an implicit knowledge of mathematical ideas. For example, to indicate the need for the science to be equal, children might sweep the palm first under a problems left side, and then under it's right side. Although those children weren't ready to turn that implicit knowledge into action, at that point they solved the problems incorrectly. A second study showed that gesturing set them up to benefit from subsequent instruction. In that study the researchers assessed how gestures versus no gestures students, performed after subsequent instruction in how to solve the math problems. At post test, children who have been told to gesture about math problems, and then had a lesson solved 1.5 times more problems correctly as to the children who had been told not to gesture, a significant advantage.


The authors conclude, telling children to gesture encourages them to convey previously unexpressed implicit ideas which in turn makes them receptive to instruction that leads learning. Gesturing appears to help children produce new problem solving strategies which in turn gets them ready to learn. The author speculate that gesturing may help kids notice aspects of the math problems that may be more easily grasps through gestural representation. The findings extend previous research that body movement not only helps people express things they may not be able to verbally articulate but actually to think better.

At the same time, gesturing offers a potentially powerful new way to augment the teaching of math. Strategies for math problems that focused on externalizing working memory, such as writing things down in certain ways, however children often find it hard to recall and use those strategies. Gesturing may be more accessible and help break through the road block.


And finally a study from The Medical University of South Carolina published the November 2007 issue in the "Journal of Pediatrics", demonstrated that in relation to other professional values, future pediatricians underestimate the importance of teaching and research in their careers. For the nation's families that could mean fewer pediatric specialists to care for children and fewer researchers to make and apply important discoveries. A finding about the lack of value placed on scholarly pursuits, could have significant workforce implications in terms of those who are willing and available to conduct important pediatric research or teach subsequent generations of pediatricians. And the result also speaks largely about female pediatricians and their values. As females accounted for more than 70% of pediatric residence in 2002 and their numbers continue to climb. Come on guys, all you male medical students out there, we need a few more men in pediatrics, the findings of this study are sounding alarm bells because we have an unprecedented number of basic research discoveries and new therapies that are ready for testing to improve children's lives said Bernia Maria, Darby Children's Research Institute, Executive Director and Principal Investigator of the study.


Although, doing research may be more important to establish doctors, the low value placed on scholarship especially among women entering the field of pediatrics is problematic. We must do a better job of mentoring talented, young investigators so children can benefit fully from today's research. Study participants included recently graduated medical students, registered to use the careers in medicine website operated by the Association of American Medical Colleges, who choose pediatrics as their specialty and who have been in residency training for two years or less.

The sample is also representative of the increased number of women going into pediatrics because 73% of the respondents to the study were in fact women. Participants completed the physician's values and practice scale. The scale is a measure of personal values related to the practice of medicine which include prestige or the desire to be recognized by others as top physician.


Service, or the desire to care for others regardless of financial gains or other rewards. Autonomy, the importance of freedom, independence and control over clinical decision making. Lifestyle, a desire for a predictable and stable work schedule. Management, the desire to supervise and have responsibility for others and scholarly pursuits, the desire to engage in clinical or basic research and scholarship activities, academic, medicine and teaching.

Autonomy and lifestyle were the top ranked values over all among medical students from all disciplines. And this finding is particularly interesting given the current shift to emphasizing teams of physicians and scientists. Similar to other disciplines, future pediatricians seek freedom, independence, control over clinical decision making and work life balance as most important.


At the national level, Dr. George Richard, Director of the Association of American Medical Colleges, Careers in the Medicine program and the facilitator of the study, says the paradox created by what is valued most by future pediatricians when compared to what is needed to maintain and advance the pediatrics field. Medical students needs to find a place in the world of work where they can function more effectively. He said, "Our research points to some of the most important factors that helped them do that while at the same time informing educators about the impact of the environment on the ability to reach one's full potential. The author suggests several factors put a gap between the low value placed on scholarships by tomorrow's pediatricians and the need for more teachers and researchers in pediatrics. Low number of women in the academic leadership roles may add to student's perceptions that scholarships and academic medicine pursuits are of less importance to future doctors. Additionally, residents current role models may under estimate the importance of scholarship in environments where clinical quote as are stressed before research experience.


In addition to understanding value difference between men and women entering different fields of medicine, we will now examine generational differences in values because older generations have the responsibility to prepare this new wave of young physicians and to close gaps in projected work force shortages in pediatrics and other fields of medicine. Sounds like a giant guilt trip, doesn't it?

All right, we are going to take a quick break and we'll be back to wrap things up right after this



I think part of the problem is that the typical person who goes into pediatrics is usually pretty much a people person. Because when you are trying to decide a specialty in medical school, really the vast majority of people are thinking about it from a clinical stand point. And in only later they get interested in research. I know that's not true, 100%, but for the majority, I do think it is. And the people pretend not to like to do bench research, and so it does make it tough to find people who want to go into pediatric research unfortunately.

All right, thanks go out to Nationwide's Children Hospital for providing the band width for this podcast. Also to Medical News Today for being our news partner. Vlad, over at Please support him and his artwork. He provides all the great drawings that you see on the website and in the feed. And of course, thanks to all of you, and my family. Speaking of family, if you check out Karen's Pedia Scribe blog, one of my favorite recent posts of hers is called "Family Traditions That I've Killed"


If you want to see how abnormal our family is and maybe make yourself feel a little more normal, then you might want to check out Karen's blog over at Pedia Scribe. There's a link to that in the Show Notes, and there is a link to the whole blog at the Show Notes page too, so and you can get there from there.

Don't forget we have an audience survey on the website in the side bar. The PediaCast shop is open with t-shirts. We have a poster page, so you can print out posters and hang on bulletin boards to help spread the word about PediaCast. And of course, your nice comments by word of mouth. And in iTunes reviews are also very appreciated. Tomorrow, we going to answer more of your questions and until then, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long everybody. No trigger happy on the finger.



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