Child health: research highlights

In the United States, more children are becoming obese at a younger age than in the past.Credit: Dan Atkin/Alamy Stock Photo

Vitamin D deficiency associated with COVID-19

Since the start of the COVID-19 pandemic, it has been suggested that vitamin D may help protect against infections and serious illnesses. The “sunshine vitamin” is known to stimulate the production of antimicrobial peptides in the respiratory tract. But its impact has proven difficult to quantify. A systematic review of half a dozen studies by Komal Shah of the Indian Institute of Public Health in Gandhinagar and her colleagues found that low levels of vitamin D were clearly associated with an increased risk of infection and poor outcomes in children with COVID-19. half of the children with COVID-19 in the review sample were vitamin D deficient.

More than a dozen randomized clinical trials have been conducted on the therapeutic and prophylactic effects of vitamin D in people of different ages in several countries. Findings are highly variable, ranging from no effect to a strong protective effect. The researchers caution that if vitamin D is having an effect, it is becoming increasingly difficult to detect against the backdrop of effective vaccines and treatments.

QJM 114447–453 (2021); Nature Rev. Immunol. 22529–530 (2022)

Obesity in the United States is expanding

The number of overweight children in the United States is on the rise. Solveig Cunningham, a public health epidemiologist at Emory University in Atlanta, Georgia, and her colleagues examined obesity rates in children between the ages of 5 and 11 over two time periods: 1998–2004 and 2010–16. The children were participants in the Early Childhood Longitudinal Study, a long-term American study of child development.

The researchers found that despite continued policy efforts to tackle unhealthy weight, young people born in the most recent period had higher rates of obesity and more severe obesity at a younger age than those born 12 years later. early. Among children aged 5 years, obesity rates increased from 12% in 1998 to 15% in 2010; by age 11, obesity levels reached about 20% for both time periods. The researchers suggest that more research into the social and biological sources of early-onset obesity should be focused on preschoolers. They speculate that policies beyond the usual encouragement of exercise and good diet may be needed to change these children’s developing weight problems and behavioral habits early in life.

Pediatrics 150e2021053708 (2022)

Early births increase the risk of ADHD

A study of attention deficit hyperactivity disorder (ADHD) lends further weight to the recommendation that elective deliveries of babies should not be planned before 39 weeks’ gestation, as those few extra days or weeks can be crucial for development of the fetus.

ADHD affects about 10% of students in the United States. Research shows that babies born before 37 weeks tend to have higher rates of ADHD. Nancy Reichman, a health economist at Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey, and her colleagues looked at the incidence of ADHD in children born in the later window of 37 to 41 weeks.

The team examined data from 1,400 children in the Fragile Families and Child Wellbeing Study, a US cohort study that analyzed children born in 75 hospitals in 20 large US cities between 1998 and 2000. When the children were 9 years old, the research team interviewed their teachers to get a good idea of ​​the attention levels of children in the classroom. They found that children born at 37-38 weeks’ gestation had an average of 17% higher ADHD scores than children born at 39-41 weeks.

The American College of Obstetricians and Gynecologists already recommends that elective deliveries not take place before 39 weeks, but more than 10 percent of them still do in the United States, Reichman says. The study adds another reason to push for later screening procedures and suggests that screening for ADHD would be beneficial for children born before 39 weeks.

J. Pediatr. (2022)

Child suicide is on the rise in the US

Suicide is one of the 10 leading causes of death for children 12 and younger in the United States, and the number of suicides is on the rise. James Price, professor emeritus of health education and public health at the University of Toledo, Ohio, and Jagdish Khubchandani, a public health researcher at New Mexico State University in Las Cruces, analyzed suicides in the United States from 2010 to 2019. They say the suicide rate for children under 12 increased by an average of 138% during that period. Girls are particularly vulnerable – levels increase by 300% in girls, compared to 95% in boys. Rates rose 95% for black children and 158% for white children.

Previous studies have similarly noted an alarming increase in child suicides in the United States. The reasons for these high rates are not exactly known, but include mood disorders, exposure to trauma, and access to firearms.

National statistics show that the overall suicide rate in the United States declined slightly in 2019, and that has continued into the pandemic: Suicide rates were 3% lower in 2020 than in 2019. But Marie- Laure Charpignon, who studies social and engineering systems and statistics at the Massachusetts Institute of Technology in Cambridge, and her colleagues reported that although overall suicide-related deaths in the United States declined during this period, the same was not true among adolescents. From 2019 to 2020, on average, suicide rates among people ages 10-19 increased in the team’s sample of 14 states.

In 2021, the American Academy of Pediatrics, along with other hospital and psychiatric associations, declared a national child and adolescent mental health emergency, calling for more funding for screening and mental health care.

J. Community Hello 47232–236 (2022); JAMA Pediatr. 176724–726 (2022)

Cannabis is transmitted through breast-feeding

Marijuana use has risen to about 4-6% among pregnant and lactating women in the United States, despite general medical advice to avoid cannabis use during these periods. The Chicago, Illinois-based Academy of Breastfeeding Medicine, for example, recommends against using marijuana while breastfeeding.

Surveys show that nearly 70% of pregnant women believe that casual marijuana use is generally safe during pregnancy. A study by Michael Moss, a toxicologist at the University of Utah in Salt Lake City, and his colleagues adds some much-needed data to the topic. They looked at 20 well-educated nursing mothers in Oregon who used medicinal cannabis daily. The team found that more than half increased their use of cannabis after giving birth, possibly to combat lack of sleep or anxiety. The study showed that the chemicals found in cannabis – tetrahydrocannabinol (THC) and cannabidiol (CBD) – accumulate in breast milk, resulting in an average dose of THC for infants of 4.1 micrograms per kilogram per day. There are no generally accepted guidelines for a safe limit of THC in any age group. Given that both cannabinoids are clearly present in breast milk and are known to affect the brain, the authors argue that research into the health and neurodevelopmental effects of infants exposed to these compounds is urgently needed.

Pediatr. Res. 90861–868 (2021)

Genetic factors in sudden infant death syndrome

The incidence of sudden infant death syndrome (SIDS, sometimes called crib death) has declined in rich countries over the past few decades, but the syndrome still kills 0.1–0.8 babies per 1,000 births, making it one of the leading causes of infant death. There are many well-known risk factors for SIDS, including babies sleeping on their backs, overheating and maternal smoking during pregnancy. And previous studies have found pathogenic variants in a set of 200 heart genes in up to 30% of SIDS cases, suggesting a genetic role in SIDS related to heart function.

Cordula Haas, a geneticist at the University of Zurich, Switzerland, and Jörg Thomas, an anesthesiologist at the University Children’s Hospital Zurich, and their colleagues studied genes involved in breathing control, such as those that code for chemoreceptors and ion channels responsible for detecting low oxygen levels. The team screened data from 155 children who died of SIDS and found that 5 had potentially pathogenic variants in a set of 11 genes known to be involved in ventilatory control.

The authors conclude that breathing-related genetic variants may be factors (but probably not the sole cause of death) in a small proportion of SIDS cases. This discovery may help unravel the possible genetic causes of this devastating syndrome.

Pediatr. Res. 921026–1033 (2022)

Tracked leukemia genes

More than 90% of children with acute lymphoblastic leukemia (ALL), the most common form of childhood cancer, survive, but the condition remains the leading cause of death from the disease in young people. For those who don’t respond well to treatment, a new genetic map of the condition may point the way to better outcomes.

Charles Mulligan, a cancer researcher at St. Jude Children’s Research Hospital in Memphis, Tennessee, and colleagues sequenced the genomes of 2,754 children with ALL. The researchers identified 376 significantly mutated genes that can drive cancer development, 70 of which had never before been implicated in ALL. Each child had fewer than ten mutations, which Mulligan says should help precisely track the disease and design targeted therapies.

Nature Married. 541376–1389 (2022)

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