Infants And Probiotics

     One of the hottest nutritional topics today is the “good” bacteria that live in our intestines. These bacteria are called probiotic bacteria and they aid in digestion, help our immune systems, decrease the risk of allergy and produce helpful nutrients.  The most common species of these bacteria is named Lactobacillus. These bacteria live normally in our gut, but also can be taken orally in liquid form, capsules or in eating live-culture yogurt.

     We also hear a lot about prebiotics. These are sugars (“oligosaccarides”) that promote the growth of the “good” probiotic bacteria in the gut.  These sugars occur naturally in foods or can also be added in the diet.

     Research has shown that breast-fed infants have more of the helpful probiotic bacteria in their intestines than infants who are formula-fed. This may be due to the fact that there are many more prebiotic sugars in breast milk than in formula. That could result in more bacterial growth. Formula companies now add prebiotic sugars to their formulas to increase Lactobacillus in the intestines of formula-fed infants. They also add “FFA” – another nutrient that promotes Lactobacillus growth.

     A study published in JAMA Pediatrics in January of 2014 looked at 468 infants in the first 3 months of life and examined the effect that giving live Lactobacillus had on colic, spitting-up and stool patterns. They defined colic as “inconsolable crying”.  They gave the Lactobacillus in liquid drops to half of the infants and gave just the liquid drops without the Lactobacillus to the other half. The study did not discuss whether it is better to breast feed or formula feed, it only looked at whether adding extra Lactobacillus would be helpful to the infant.

     After three months, the parents were asked to report how many hours the infant spent in inconsolable crying. The infants who were given the probiotic bacteria were reported to spend only half as much time crying as the infants who did not get the probiotic drops. The infants who received probiotic drops were also reported to have almost 50% less spitting-up, more frequent stools, and less solid stools. No one is recommending adding yogurt to the diet of formula-fed infants yet, but it will be interesting to see the results of further studies.

     Almost 25% of pediatric visits to the doctor in the first 4 months of life are because parents are concerned about colic, spit-up or digestive problems. If increasing the growth of normal bacteria in the gut could reduce these problems, it could result in a decrease in clinic and ER visits, a decrease in the cost of infant care and less worry for parents.

The Pause That Refeshes

     In almost every discipline/behavior advice-book there is one repeated message for parents: “take a breath”. Pausing before you react to your child’s behavior gives you a better chance of reacting in a way that will be positive for both you and your child. In some situations, you will need to give positive reinforcement, in others, negative reinforcement and, in others, no reaction at all. But, in every situation, taking a moment to dial down your emotional reaction and dial up your thought process will help you to strike the right parental tone.

     Children react immediately. Whatever they are feeling it is immediately out in the open. As a parent, it is hard not to be caught up in that reaction. An infant screams in frustration because he doesn’t know what is wrong with him, but knows something is wrong. The resulting guilt, irritation and frustration generated in the parent can lead the parent into a meltdown, too. The toddler who hits or bites can produce not only pain, but also fear, worry and anger in a parent – all of which can produce an emotional over-reaction unless the parent takes a “stop-and-breathe-deep” moment before reacting. The food-refusing five year-old is guaranteed to produce frustration. And teenagers go out of their way to get an emotional response from parents.

     Every interaction a parent has with a child teaches the child something. Too often, when I looked back and thought about an interaction I had with my children, I found myself thinking, “Well, I didn’t want to teach them THAT!” Most of those times, it was because I reacted immediately instead of taking a moment to consider what was really going on in the interaction and what my options for reaction were. Children lose control; parents don’t need to.

     That is not to say that a parent’s every response should be soft and sweet. Some behavior needs a firm, negative reinforcement and the best one is a stern, in-your-face, nothing-nice-about-it “NO”. But, even in those cases, an initial slight pause gives us the chance to think about the situation and decide how we want to react.

     For repeated behavior, consulting the discipline/behavior books and talking with your caregiver and other parents will give you options for the next time the child does the behavior. But, even when you’ve scripted a response, take that “O.K.-I’m-in-control-breath” first.  It’s better for both of you.

Allergy To Diaper Wipes

     The December issue of Consultant For Pediatricians had a report of a five-year-old girl who developed a red, slightly raised rash on her face around her mouth and on her buttocks. The rash was caused by an allergy to diaper wipes that her mother was using to clean off the area around her mouth after meals. The mother also had the child use the wipes instead of toilet paper.

     The report states that diaper wipes have a chemical called MCI/MI (the actual chemical name has 47 letters in it!) or trade name KathonCG. This chemical is a preservative put into the wipes to keep them moist. It commonly causes allergic reactions.

     Pre-moistened cleansing wipes have been used with diaper changes in infants for a long time, but they are now also used as a flushable alternative to toilet paper for adults, as hand and face cleaners and as makeup removers. The wipes are convenient at times but people sometimes feel that the wipes are better for “killing germs” and then use them as general skin cleansers.

     If an infant, child or adult develops a rash in an area where these wipes are used, an allergy should be suspected and the use of the wipes should stop.

     This case points out the fact that using a soft cloth and water is still the best way to clean a child’s face, hands or diaper area. Many people now use wipes because of a fear of germs and the obsession this country has developed about “cleanliness”. But we are now learning that many of the chemicals in our environment are bad for us while many of the “germs” in our environment are good for us.

What's New In ADHD?

     There are standard guidelines that all caregivers use to make the diagnosis of Attention Deficit/ Hyperactivity Disorder. These guidelines are published in a manual called the “Diagnostic and Statistical Manual of Mental Disorders” (DSM). In 2013, a new, 5^th edition of the DSM was published.

     At first, there was criticism that the new manual loosened the criterion for making the diagnosis of ADHD. The concern came from a commonly-stated fear that ADHD is already over-diagnosed and over-treated. But the new diagnostic guidelines are only minimally different from the previous guidelines. The same questions are asked about inattention, hyperactivity and impulsivity – the main symptoms used to diagnose ADHD. With the old guidelines, we asked if any of these symptoms were present before age 7. The new guidelines liberalize that slightly by saying “before age 12”. They also require that “several” of the symptoms are present in more than one setting – school, home, or other settings outside the home. The only change that made the diagnosis of ADHD “easier” was that less criterion were required to make the diagnosis of ADHD in adults.  This makes sense because some of the ADHD symptoms are different in adults –for example, there is less hyperactivity.

     Because the diagnosis of ADHD is still made from a child’s history rather than using a “test”, it is important that caregivers have clearly outlined diagnostic criteria. Having standard guidelines that we all can refer to helps to ease parents’ concerns about over-diagnosis. It is important for parents to have confidence in a caregiver’s diagnosis of ADHD because untreated ADHD can result in to school failure, depression, drug abuse and suicide.

     Other recent studies have repeated the previously known facts that ADHD is not a dietary deficiency, food allergy or simply “a behavior problem.” Agreement was also reached that there is no connection between the use of ADHD medication and sudden death in children from heart problems (another commonly stated fear). The American Academy of Pediatrics recommends that any child with ADHD have a thorough medical history review which includes the family cardiac history, but it does not recommend that caregivers obtain an electrocardiogram (EEG) in a child before starting ADHD medication.

     There is one new test that might make the diagnosis of ADHD easier. In 2013, the FDA approved for marketing a specialized measurement of brain waves called the Neuropsychiatric EEG-Based Assessment System. This is a test that measures certain types of brain waves that seem to be more common in children with ADHD. Whether or not this test will finally offer a “more scientific” way of making the diagnosis of ADHD remains to be seen.

    

Measles Vaccine and Fever Seizures

     In 1998, Andrew Wakefield reported in the English journal Lancet that he thought measles vaccine was a cause of autism. This was rapidly spread throughout the world and has been repeated in many forms since. We know now that the report was false and was generated by Wakefield’s ties to a suit against the vaccine manufacturer. It has been described as “the most damaging medical hoax of the last 100 years”.

     Although measles vaccine has absolutely no connection to autism, it does have side effects parents need to be aware of. One of those side effects is a fever (febrile) seizure.

     Because measles vaccine is a live vaccine, it can give a child a mild case of measles that can be associated with a few days of fever. Fever in a child in the 12 to 15 month age group (when measles vaccine is given) can cause a fever seizure in a small percentage of children. These fever seizures are frightening but not dangerous (see “Fever Seizures” Jan 2013).

     A study in the journal of the American Medical Association Pediatrics published in October 2013 examined how delaying the measles vaccine affects fever seizure. Parents sometimes choose to give their children vaccines on an alternative schedule (see “Alternative Vaccine Schedules” Jan 2013) to “wait until the child gets older”. Statistically, many parents “hold off” on the measles vaccine until the child is up to 19 months of age.

      Information for the AMA study on fever seizures was collected from 9 million records of members of HMO’s and reports to the CDC in Atlanta. 840,348 infants were included in the study. The results of the study clearly showed that delaying the measles vaccine until the child was 16 to 23 months of age was associated with a greater risk of having a fever seizure 7 to 10 days after the immunization. Although the cause for this is unknown, it was postulated that the child’s immune system mounts a stronger response when the child is older and this stronger response may cause more fever seizures.

     Some people who advocate against all vaccines say that the fever seizures that can result from the measles vaccine are a reason not to get the vaccine at all. But not vaccinating exposes the child to the risk of acquiring real measles that can often infect the brain and cause not only fever seizures but also permanent brain damage. As with all vaccines, there is always a slight risk of complications from the vaccine, but the risk is much less than the risk of complications that can occur if the child gets the actual disease.

     The best age to give a vaccine is a subject that has been studied by many researchers over a long period of time. The October study reinforces the fact that there is a “best age” for a vaccine and advises that parents adhere to the recommended schedule and give measles vaccine in the 12 to 15 month of age time period.