Do dogs prefer female voices? Plus, more screen time for babies ...
Transcutaneous Auricular Vagus Nerve Stimulation Beneficial In Pediatric IBD
FRIDAY, Oct. 20, 2023 (HealthDay News) -- For pediatric patients with mild-to-moderate inflammatory bowel disease, transcutaneous auricular vagus nerve stimulation (ta-VNS) attenuates signs and symptoms of disease, according to a study published online Oct. 18 in Bioelectric Medicine.
Benjamin Sahn, M.D., from the Steven & Alexandra Cohen Children's Medical Center at Northwell Health in New Hyde Park, New York City, and colleagues randomly assigned patients aged 10 to 21 years with mild/moderate Crohn disease (CD) or ulcerative colitis (UC) and fecal calprotectin (FC) >200 µg/g within four weeks of study entry to receive either ta-VNS targeting the cymba conchae of the external left ear or sham stimulation of 5 minutes in duration once daily for two weeks, followed by crossover to the alternative stimulation. All participants received a ta-VNS of 5 minutes in duration twice daily at week 4 until week 16.
Twenty-two patients were enrolled: 10 with CD and 12 with UC. The researchers found that among the 12 patients with active symptomatic disease indices at baseline, clinical remission was achieved in three of six (50 percent) and two of six (33 percent) with CD and UC, respectively, at week 16. Five patients were excluded from the FC analysis due to FC levels <200 µg/g at baseline. Of the remaining 17 patients, 11 (64.7 percent) with baseline FC ≥200 µg/g had a ≥50 percent reduction in FC at week 16. The median reduction in FC versus baseline was 81 and 51 percent in the UC and CD patients, respectively, at 16 weeks. No safety concerns were reported.
"Neuromodulation therapies such as vagus nerve stimulation have the potential of becoming an important tool in the treatment toolbox for patients with IBD," the authors write.
About 37% Of Toddlers With Autism Do Not Meet Criteria For Condition By Age 7
New research suggests that some toddlers diagnosed with autism may not meet the condition's diagnostic criteria by age 7. The study, published in JAMA Pediatrics, looked at 213 children diagnosed with autism at 12 to 36 months of age and reevaluated them at 5 to 7 years old after some form of treatment.
Nearly 40% of children studied were no longer considered autistic by age 7. In the study, they are referred to as having non-persistent autism spectrum disorder.
Autism, or autism spectrum disorder (ASD), covers a broad range of conditions that revolve around challenges with social skills, repetitive behavior, speech, and nonverbal communication.
Autism affects 1 in 36 children in the United States, according to the Centers for Disease Control and Prevention.
To meet the criteria for an ASD diagnosis, a child must have persistent challenges in each of three areas of social communication and interaction, plus at least two of four types of restricted, repetitive behaviors, according to the CDC.
The study found that children who received therapy and treatment for their ASD dropped some of these required areas, which means they could no longer be categorized as having ASD.
Persistent deficits in social communication could mean failure of typical back-and-forth conversation, poorly integrated verbal communication, abnormalities in eye contact and body language, difficulty in understanding relationships or difficulty making friends.
Restricted patterns of behavior, interests, or activities could mean repetitive motor movements or use of objects, insistence on sameness and inflexible adherence to routines, highly restricted and fixated interests that are abnormally intense, and hyper- or hyperactivity to sensory input.
The objective of the study was to determine the frequency with which children who are diagnosed with ASD at 12 to 36 months of age continue to meet the criteria at 5 to 7 years of age, and whether interventions can help with ASD persistence.
"While prior research has shown that there can be changes in whether or not children meet diagnostic criteria for ASD over time, this study included young children diagnosed with a DSM-5 clinical ASD diagnosis and followed until age 5-7 years old, which is older than some of the other studies," said Dr. Elizabeth Harstad, study author and assistant professor of pediatrics at Harvard Medical School.
The team looked at 213 children that had been diagnosed with ASD between the ages of 12 to 36 months.
"In contrast to previous studies, this study found that 37.1% of children initially diagnosed with autism between 12-36 months did not meet the criteria between the age of 5 to 7 years," said Dr. Dyan Hes, a pediatrician at Northwell Lenox Hill Hospital.
"The results demonstrated that two factors were associated with the group that had non-persistent ASD. Both higher baseline adaptive skills between the ages of 12 to 36 months and female sex were associated with non-persistent ASD."
Hes was not involved in the study.
This means that the kids who no longer met the diagnostic criteria for ASD were more likely to be girls or at baseline to have better communication and decision-making skills.
"As is recommended for young children with an ASD diagnosis, all children in this study received some type of intervention after ASD diagnosis, and 94% received ASD-specific interventions, such as Applied Behavioral Analysis," said Harstad.
"For young children with a clinical diagnosis of ASD, behavioral interventions such as this are recommended to help children with their social communication skills and other areas of development. Children may also benefit from speech and occupational therapies and interventions to find their optimal ways to communicate, whether through speech, gestures, signs, augmentative communication, and/or other strategies," Harstad added.
Applied behavioral analysis (ABA) is a therapy based on the science of learning and behavior. It includes behavior training like positive reinforcement and Antecedent-Behavior-Consequence (ABCs).
An antecedent (A) is something, such as a request or command, that occurs before a behavior or may trigger a behavior.
Behavior (B) is the response to the antecedent.
The consequence (C) is what happens immediately after the behavior.
ABC analysis aims to understand how certain behaviors serve an individual with ASD and how certain consequences could affect a change in behavior.
"Of note, there was no correlation with the intensity of behavioral interventions in the 18 months after ASD diagnosis and non-persistent ASD," said Hes. "Children in the study with higher adaptive skills under 36 months of age also required fewer hours of behavior intervention as they got older."
This does not mean that ABA therapy for ASD does not help, but it suggests there are other factors that may predict non-persistent ASD.
"This study reinforces the idea that a diagnosis of ASD early on needs to be reevaluated as the child ages," Hes said. "It is more fluid for some children, and they may not meet the ASD criteria as they become school age."
One point the researchers make is it is important for children with autism to have continued assessments throughout their development. The diagnosis may evolve over time and the treatment must evolve with them.
Doctors are still trying to understand why some children develop autism. However, according to the National Institute of Environmental Health Sciences, risk factors for autism may include:
There is no medical test to diagnose ASD. Doctors have to study a child's developmental history and behavior. Autism can be diagnosed at 18 months or earlier.
Developmental screening is one of the key ways to diagnose autism.
The American Academy of Pediatrics (AAP) recommends developmental and behavioral screening at 9 months, 18 months, and 30 months. The AAP also recommends screening all children for ASD at 18 and 24 months.
A new study published in JAMA Pediatrics found that 37% of children diagnosed with autism at 12 to 36 months no longer met the criteria of the condition by age 7.
Experts say early intervention following an autism diagnosis is key for managing symptoms.
Yes, You Need To Ask About Guns In The Home Before Play Dates
You've probably heard it before: You really should ask about guns in the home before your child goes over to a new friend's house to play. It seems like a good idea, sure, but also that conversation sounds like a pretty awkward one to have with people you barely know. Still, as pediatric gun deaths rise around the country, doctors are urging parents to start getting comfortable with these initially uncomfortable conversations, as they may save your child's life. We asked Dr. Chethan Sathya, a pediatric trauma surgeon at Northwell and the director of Northwell's Center for Gun Violence Prevention, who is committed to normalizing conversations about gun safety and has developed many resources — from scripts to slogans — to help parents who still feel shy about broaching the subject feel more confident.
Why parents need to ask about guns in the house"Parents need to ask about guns in the household because having a gun in a household that is not securely stored significantly increases the risk of suicide and homicide in the household, as well as accidental injury," Sathya explains. He says that guns that are securely stored are ones that are stored:
If your kids are in a house where there's a firearm that is not securely stored, data shows that it's possible for them to easily pick up that gun. "They're curious and they can accidentally shoot themselves, a parent, a loved one, or a friend," Sathya says. "Upwards of 5 million kids in America live in households with loaded and locked guns, and we see kids that do accidentally injure again themselves or kill another kid by accident because they're playing with a gun."
Studies show that no matter how young a child is, even kids who are age 3 to 5, can find a gun and can operate and pull that trigger if there's nothing that stops them from doing that. In fact, a 2021 report from Everytown for Gun Safety found that almost one in three unintentional shooters were preschoolers. Unless parents have their household gun securely stored, sending a child to a playdate at a home with a gun comes with a significant risk.
Particularly of concern for children older than preschoolers is the possibility that your child is having some sort of mental health issue, Sathya says. "If they're suicidal, if they have access to a gun in someone else's house, they could use that weapon to intentionally kill themselves." In light of these uncomfortable realities, he says parents must get used to asking these questions right alongside questions about who's watching the kids when they're swimming and if their friends' house has baby gates or other safety precautions in place. "Just like we ask about other dangers when we send our kids over to someone's house, we need to get normalized in asking about firearm safety."
How to ask about guns in the housePediatricians like Sathya have learned to get comfortable asking about guns in the home and firearm storage, and he recommends parents take the same approach they do: "Loop it into other questions. Hey, do you guys have any child safety gates? Is there a pool? Anything else we should worry about? Do you guys happen to have a gun?"
Many of us already are in the habit of asking a few questions related to safety before our kids go to a new friends' house. Maybe your child has allergies, or is afraid of dogs — whatever the thing you usually warn about or ask about, consider looping in a question about guns and storage.
If that still feels awkward, Sathya's best trick is simply to outsource the decision to ask about guns to your family doctor. "Literally say, my doctor told me to ask."
The 2 essential questions to ask about guns in the home:If your child is school-age, you've probably felt the need to talk with them about guns, or they may have even come home after a school lockdown drill full of questions. Maybe you don't allow toy guns, and that has prompted tricky conversations. Whatever the reason, Sathya says that while it's fine and good to teach little kids that a gun is dangerous — the same way we teach them that boiling water is too hot to touch, and it's dangerous to run into the street — parents shouldn't rely on conversations with their child to protect them from firearm dangers. As parents of little kids know, "just telling them to avoid something will not make them avoid it," he says. Conversations with our kids about guns are OK, and even can be good, but Sathya stresses that they must be paired with these life-saving parent-to-parent conversations about guns and gun storage.
What to do we tell our children what to do if they see a gun in someone's home or at school? "I would tell my kids that it's something that they shouldn't touch, and that if they find one or see one, don't grab it, just call an adult," he says.
Perhaps surprisingly, Sathya feels strongly that the leading change agents for gun safety and reducing kids' gun deaths are going to be parents who own guns, and he urges parents not to think of guns as a political issue, but rather as a question of public health that we can all agree on. No one wants kids to die. "Learned gun owners are the most strident advocates of firearm safety," he says. "The issue is that there are many Americans and parents who bought guns during the pandemic and post-pandemic that have never operated a gun before. They don't necessarily understand the risks. They don't think their kids can pull the trigger and kill someone or themselves."
If you are a parent who does have guns stored safely in the home, Sathya says that preempting these conversations can be a great way to not only ensure your child's safety, but also a significant opportunity to educate others. For example, if a child is coming to play at your house, you may help normalize these conversations by offering up the fact that you do have a gun in the home, and share the details of how you safely store it. In doing so, you lay the foundation for having that same conversation when it's time to send your child to their home.
What to do if you don't feel comfortable with the answer you get about guns in the homeOf course, this will depend somewhat on how close you are to this other family, and your overall comfort levels. But if it's a situation that you're uncomfortable with, then you might have to elect to not send your kid over there at that time and explain why, or simply have play dates at your own house, Sathya suggests. Because yes, having this conversation does carry the risk that you'll get an answer you don't like. "Most of the time, we have found that when we have alternate opinions among families that we bring up this issue with, they're very receptive to the idea [of safe storage]. In the minority of cases where there is a gun that's not stored safely, your options are either to educate that person and maybe offer an alternative or have the kids maybe meet outside at a park or something like that."
What if you feel uncomfortable asking about guns before play date?
Unfortunately there are no easy tricks for getting started, but Sathya promises that it gets easier every time you do it. "It's only going to start by trying," he says, urging parents to read up, and get educated on what it really means to safely store a weapon so that you feel more confident in broaching the topic.
Most of all, Sathya says that parents have to get away from thinking of this as a political issue, or one that doesn't affect them or their child. "If you view it as a political issue, we're never going to have change. Kids are going to keep dying. None of us are that far removed from people who've been affected by firearm death. This is something that can happen to your kid, no matter what." A simple conversation really can help protect your kid. And, as these conversations become more broadly normalized, hopefully they will help protect all of our children and eventually help bring an end to the gun violence epidemic.
Studies cited:
Lee, L., Fleegler, E., Goyal, M., Fraser, K., Laraque-Arena, D., Hoffman, B., MD, (2022) Firearm-Related Injuries and Deaths in Children and Youth: Injury Prevention and Harm Reduction. Pediatrics, https://publications.Aap.Org/pediatrics/article/150/6/e2022060070/189686/Firearm-Related-Injuries-and-Deaths-in-Children?Autologincheck=redirected
Forde, K., et al, (2021) Preventable Tragedies: Unintentional Shootings by Children. Everytown For Gun Safety, https://everytownresearch.Org/report/notanaccident/
Experts:
Dr. Chethan Sathya, a pediatric trauma surgeon at Northwell and the director of Northwell's Center for Gun Violence Prevention
Comments
Post a Comment