When Parents Get Active, So Do Kids: Study

HealthDay – 5 mins ago THURSDAY, Aug. 2 (HealthDay News) -- Parents who want to increase the amount of exercise their children get should become more active themselves, according to a new study.

"It has long been known that parent and child activity levels are correlated," study author Kristen Holm, an assistant professor of medicine at National Jewish Health in Denver, said in a news release. "

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More Drug Trials Needed for Conditions Affecting Kids: Review

HealthDay – 6 mins ago WEDNESDAY, July 25 (HealthDay News) -- A new review finds that while children account for almost 60 percent of those with five common medical conditions, only 12 percent of clinical trials of drugs for those conditions examined their effects on pediatric patients.

Yet, the review authors noted, previous research has shown that off-label drugs, where the medicine has only been approved for adult use by the U.S. Food and Drug Administration, make up as much as 79 percent of the medications given to children in hospitals and up to 56 percent of drugs prescribed for kids in doctors' offices.

"We think this contrast is striking, and speaks to the under-representation of research on kids," said review author Dr. Florence Bourgeois, an assistant professor of pediatrics at Boston Children's Hospital and Harvard Medical School in Boston. "Understandably, whenever we see an adverse event the concern is, 'Could these drugs really be dangerous?' and we are left wondering."

The results were released online July 23 in advance of publication in the August print issue of the journal Pediatrics.

The FDA requires that clinical trials demonstrate a drug's safety and effectiveness for a condition before it approves the drug to treat that condition, but many drugs are only tested in adults. As a result, physicians are often left to rely on trial-and-error to decide how to use drugs off-label in children, the review noted.

Bourgeois and her team found that, while just over 21 percent of people in high-income countries who are afflicted by conditions such as depression, asthma, migraines, schizophrenia and bipolar disorder are children and adolescents, less than 10 percent of clinical trials studying these conditions included patients under the age of 18.

The gap was even wider for developing countries, where children and adolescents bear nearly 62 percent of the disease burden for conditions such as malaria, diarrhea, HIV and depression, but only about 12 percent of clinical trials of treatments for these diseases include pediatric patients.

A number of professional organizations, including the Institute of Medicine, the American Academy of Pediatrics and the Royal College of Paediatrics and Child Health in England, have all published statements on the importance of evaluating medical treatments for children using randomized, controlled trials. A randomized, controlled trial, in which study participants are randomly chosen to either receive a treatment or not, is the gold standard for medical research.

"In some instances, it may be fine to extrapolate adult

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More ADHD drugs, fewer antibiotics for US kids: study

"A pediatrician performs a check-up on a child at the University of Miami Pediatric clinic in 2007 in Miami, Florida. More drugs for attention deficit hyperactivity disorder and fewer antibiotics are being prescribed to US children and teenagers compared to a decade ago. (AFP Photo/Joe Raedle)" title

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Key to More Active, Slimmer Kids: Friends

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Injury deaths drop among US kids: study

Injury deaths drop among US kids: …

Childhood deaths from injury have dropped almost 30 percent over the past decade, but suffocation deaths by infants and fatal poisonings among teens have risen, said a US study out Monday.

Despite the 29 percent decline, unintentional injuries are still the number one killer for US minors between the ages of one and 19, taking more than 9,000 lives in 2009, said the Centers for Disease Control and Prevention.

The US rate of unintentional injury deaths among youths in 2004 was about twice that in other high-income countries in the the World Health Organization's European and Western Pacific Regions, it added.

Car crashes dropped by 41 percent from 2000-2009, but remained the leading accidental killer among this group. The CDC attributed the decline to improvements in child safety seats and better training for teen drivers.

"Despite this success, traffic crashes remain the leading cause of death for persons in age groups 5-19 years, accounting for 67 percent of unintentional injury deaths and 28 percent of deaths from all causes among those aged 15-19 years in 2009."

Poisoning deaths among those age 15 to 19 have been rising -- up 91 percent in 2009 compared to 2000 -- along with the rest of the US population, mainly due to overdoses of prescription drugs.

The higher infant suffocation rate -- up 54 percent from 2000 to 2009 -- "could be curbed" if more parents followed pediatricians' recommendations to have infants "sleep in safe cribs, alone, on their backs, with no loose bedding or soft toys," the study added.

However, the CDC pointed out that the apparent higher rate of infant suffocation could be a result of the change of death certificate classification over time.

Such deaths were often previously attributed to mysterious "sudden infant death syndrome," but recently, more of these deaths have been classed as "suffocation" as understanding of the syndrome has improved.

"Kids are safer from injuries today than ever before. In fact, the decrease in injury death rates in the past decade has resulted in more than 11,000 children's lives being saved," said CDC Director Thomas Frieden.

"But we can do more. It's tragic and unacceptable when we lose even one child to an avoidable injury."

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Codeine After Surgery Could Endanger Certain Kids: Study

HealthDay – 57 mins ago WEDNESDAY, April 11 (HealthDay News) -- Concerns about codeine safety have gained traction in the wake of the postoperative experience of four children who all carried a rare genetic mutation. A new study describes what happened to three of the patients, while a similar case came to light in 2009.

In certain very rare genetic cases, the common painkiller codeine can be lethal. The gene mutation causes the body to metabolize codeine into morphine at levels 50 percent to 70 percent higher than normal. Among such patients, an otherwise standard amount of codeine can unpredictably turn into a toxic overdose.

After undergoing tonsillectomies for sleep apnea, three children with the gene mutation ultimately died, while the fourth patient barely survived.

"Codeine has been around for the better part of a century as a medication, including as a syrup for children," said study lead author Dr. Gideon Koren, a professor of pediatrics, pharmacology, pharmacy and medical genetics at the University of Toronto. "That's the drug that is used by most surgeons in the U.S. to control pain. But codeine is not actually the analgesic. To deal with pain it has to be transformed in the liver into morphine. And that happens with everyone who takes it to some degree," he explained.

"Most people take 10 molecules of codeine and make one molecule of morphine," added Koren, who is also a professor at the University of Western Ontario. "The problem is that our knowledge of genetics has revealed that there are people who are ultra-rapid metabolizers. They take 10 molecules of codeine and make two, three or even five molecules of morphine. In other words, they take the right doses but end up poisoning themselves."

Koren and his colleagues described the cases of the three recent pediatric codeine overmetabolizers in the April 9 online and May print issue of Pediatrics. The earlier case was reported in 2009 in the New England Journal of Medicine.

"Tragically," Koren said, "we have found that once in 2009 and again now in three additional cases, toddlers who underwent tonsillectomies for sleep apnea and then were treated with codeine were in that ultra-rapid metabolizer group that produce too much morphine. And we have every reason to believe there have been many more such cases, which of course almost certainly occurred in the past, but before anyone knew how to uncover the reason genetically."

About 2 percent to 3 percent of children have obstructive sleep apnea syndrome, which involves structural airway issues that interfere with breathing and, in turn, sleeping. And among those whose sleep apnea is caused by enlarged tonsils, tonsillectomy is often the treatment of choice.

In 70 percent to 80 percent of cases, such surgery successfully improves the patient's sleep apnea condition. And for the children in the recent case studies -- a 3-year old girl, a 4-year-old boy and a 5-year old boy -- the surgery itself was not the problem.

Instead, because of their unidentified ability to overmetabolize codeine, their problems began with the codeine prescribed for pain management after the procedure.

After they were discharged from the hospital, lethargy and signs of heavy sedation set in, as well as other symptoms, including fever, impaired breathing and vomiting. Both boys died within 24 hours after being released from the hospital, while the girl was able to survive after readmission and mechanical ventilation support.

The researchers noted that screening tests for metabolizing mutations are available. But, many medical facilities remain unaware of the risks posed by such mutations. The tests are expensive, amounting to several hundred dollars each. As a result, such screenings are not currently a routine feature of preoperative hospital protocol.

Koren said that in Europe, physicians have long since replaced codeine with nonsteroidal anti-inflammatory drugs (NSAIDs) for post-tonsillectomy pain management. This is because, along with the metabolizing issue, one effect of codeine is to inhibit breathing, which is a problem for the roughly one-fifth of pediatric patients who will still experience sleep apnea even after surgery.

But concerns about the increased bleeding that can result from NSAID usage has complicated discussions about a similar switch in the United States.

"So this situation is by no means settled yet," Koren said. "We just want to bring attention to the fact that some kids may be exposed to an unacceptable risk, and parents should know about that risk. And perhaps request and pay for a screening before an operation. People spend money on far less important things."

Dr. Dennis Woo, an associate professor of pediatrics at the University of California, Los Angeles David Geffen School of Medicine, said that while the risk of such cases is low there is a need to raise awareness.

"In the big scheme of things this affects a very small number of kids," Woo said. "But the message to the medical profession is that you need to be careful and monitor all these kids closely."

Dr. Jerry Schreibstein, a partner with the Ear, Nose & Throat Surgeons of Western New England, stressed that it should be made clear that this "very rare and unusual complication is related to the medication and not the procedure."

Schreibstein said there are risks with any surgical procedure. "And these need to be discussed fully with a physician," he said. "But there are alternatives for pain relief, with few side effects, that can be used for children. And these should be reviewed and considered. Because I'd hate to have parents walk away with the notion that it's the tonsillectomy that caused these deaths."

More information

For more on codeine and children, visit the U.S. National Library of Medicine.

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Obese Kids: Genes, Junk Food Share Blame

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Measles Vaccines Won't Raise Seizure Risk in Young Kids: Study

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