School starts too early, and we should make some noise about it.

Jason Reed / Reuters

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For the first time, the federal Centers for Disease Control and Prevention is urging education policymakers to start middle- and high-school classes later in the morning. The idea is to improve the odds of adolescents getting sufficient sleep so they can thrive both physically and academically.
The CDC’s recommendations come a year after the American Academy of Pediatrics urged schools to adjust start times so more kids would get the recommended 8.5 to 9.5 hours of nightly rest. Both the CDC and the pediatricians’ group cited significant risks that come with lack of sleep, including higher rates of obesity and depression and motor-vehicle accidents among teens as well as an overall lower quality of life.

john with child workout

We changed our minds : Oops. Food Allergy Advice for Parents: Start Peanuts, Eggs and More Sooner - WSJ.com

 When will we ever make up our minds as docs? I suppose this is the inherent virtue of science, if we learn something new, we change our minds.
Interesting notes re association with vit d deficiency and food allergy.

increasing evidence for early food introduction, and hygiene hypothesis.

We'll reverse it all in another 10 years?

From Evernote:

Food Allergy Advice for Parents: Start Peanuts, Eggs and More Sooner - WSJ.com Clipped from: http://online.wsj.com/article/SB10001424127887324662404578334423524696016.html

Food Allergy Advice for Kids: Don't Delay Peanuts, Eggs 

Infants at risk for food allergies should be gradually introduced to suspect foods to build up tolerance, according to new recommendations from a leading allergy doctor group. WSJ's Sumathi Reddy joins Lunch Break with a look at the evidence. Photo: AP.

Parents trying to navigate the confusing world of children's food allergies now have more specific advice to consider. Highly allergenic foods such as peanut butter, fish and eggs can be introduced to babies between 4 and 6 months and may even play a role in preventing food allergies from developing.
These recommendations regarding children and food allergies—a rising phenomenon that researchers don't fully understand—come from the American Academy of Allergy, Asthma & Immunology in a January article in the Journal of Allergy & Clinical Immunology: In Practice. The AAAAI's Adverse Reactions to Foods Committee outlined how and when to introduce highly allergenic foods, which include wheat, soy, milk, tree nuts, and shellfish.

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A new report recommends introducing highly allergenic foods to children earlier. The foods include eggs, fish, soy, milk and tree nuts. Above, edamame.

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Highly allergenic foods such as peanut butter, fish and eggs can be introduced to babies between 4 and 6 months.

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The recommendations are a U-turn from 2000, when the American Academy of Pediatrics issued guidelines that children should put off having milk until age 1, eggs until 2 and peanuts, shellfish, tree nuts and fish until 3. In 2008, the AAP revised its guidelines, citing little evidence that such delays prevent the development of food allergies, but it didn't say when and how to introduce such foods.
Food allergies affect an estimated 5% of children under the age of 5 in the U.S., according to the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health. The prevalence of a food allergy for children under 18 increased by 18% from 1997 to 2007.
"There's been more studies that find that if you introduce them early it may actually prevent food allergy," said David Fleischer, co-author of the article and a pediatric allergist at National Jewish Health in Denver. "We need to get the message out now to pediatricians, primary-care physicians and specialists that these allergenic foods can be introduced early."
Dr. Fleischer said more study results are needed to conclusively determine whether early introduction will in fact lead to lower food-allergy rates and whether they should be recommended as a practice.
The first trials to split children into groups, with some eating highly allergenic foods early on and others delaying, are continuing in the United Kingdom and Australia with some preliminary results expected to be out next year. This type of trial with children is rare and the results are highly anticipated.
One theory to explain why early introduction is important holds that if babies aren't exposed early enough to certain foods, their immune systems will treat them as foreign substances and attack them, resulting in an allergy.
"The body has to be trained in the first year of life," says Katie Allen, a professor and allergist at the Murdoch Childrens Research Institute at Royal Children's Hospital in Australia. (The institute was founded in part by the late Dame Elisabeth Murdoch, mother of Rupert Murdoch , who is chairman of News Corp., which owns The Wall Street Journal.) "We think there's a critical window, probably around 4 to 6 months, when the child first starts to eat solids," she says.
Another possible explanation from some experts for the increase in allergies: As westernized countries have become more hygienic, children don't have the same exposure to germs, which affects the development of the immune system.
Dr. Allen believes there may be a link between food allergies and vitamin D. In a study out this week in the Journal of Allergy and Clinical Immunology, researchers took blood samples from more than 5,000 babies and found that those with low vitamin D levels were three times more likely to have a food allergy.
Food-allergy reactions range from hives and eczema to asthma, vomiting and anaphylaxis, a life-threatening reaction in which the body's major systems quickly shut down. A 2011 prevalence study in the journal Pediatrics found that 39% of children with food allergies have a history of severe reactions.
The new recommendations include introducing highly allergenic foods after typical first foods have been eaten and tolerated, such as rice cereal, fruits and vegetables. They suggest children be fed the foods at home and in gradually increasing amounts. The AAAAI recommendations cited about half-a-dozen studies in making its new guidelines.
One observational study compared Jewish children in the United Kingdom with those in Israel, where the peanut-allergy rate is low. The 2008 study of more than 5,000 children in each country in the Journal of Allergy Clinical Immunology found the rate of peanut allergies among the U.K. children was 10 times that of those in Israel. Gideon Lack, a professor of paediatric allergy at King's College London, said the researchers followed up with surveys given to the parents of about 100 infants hundred in each country. They found that popular snacks with peanuts were given to Israeli babies often before they were 6 months of age, whereas the majority of babies in the United Kingdom didn't taste peanut products until after the age of 1.
Dr. Lack is in the midst of the much-anticipated, randomized controlled trial in the U.K., which is following 640 children with a high risk of allergy—determined by eczema—from infancy to the age of 5. Half of the children are consuming at least 24 grams of peanuts three times a week, while the others have none. About two-thirds of the children are now 5 and receiving peanut-allergy testing. Preliminary results are expected next year.
Some experts are critical of the observational studies cited in the recommendations. "The evidence that has come up is of great interest but it's all either anecdotal or epidemiological and not the intervention studies that are going on right now that will lead to answers in the next three years," said Robert Wood, director of Pediatric Allergy and Immunology at Johns Hopkins University School of Medicine.
Dr. Wood said he tells parent they don't need to feel pressured to do an early introduction. "You can do whatever you want because we're not sure what makes a difference," he said.

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Not enough sleep makes you fat

Adding substantially(  pardon the pun ) to the large data set of evidence that points to inadequate sleep contributing massively to weight gain.

Lost Sleep Can Lead to Weight Gain

By TARA PARKER-POPE

Stuart Bradford

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The best path to a healthy weight may be a good night’s sleep.

For years researchers have known that adults who sleep less than five or six hours a night are at higher risk of being overweight. Among children, sleeping less than 10 hours a night is associated with weight gain.

Now a fascinating new study suggests that the link may be even more insidious than previously thought. Losing just a few hours of sleep a few nights in a row can lead to almost immediate weight gain.

Sleep researchers from the University of Colorado recruited 16 healthy men and women for a two-week experiment tracking sleep, metabolism and eating habits. Nothing was left to chance: the subjects stayed in a special room that allowed researchers to track their metabolism by measuring the amount of oxygen they used and carbon dioxide they produced. Every bite of food was recorded, and strict sleep schedules were imposed.

The goal was to determine how inadequate sleep over just one week — similar to what might occur when students cram for exams or when office workers stay up late to meet a looming deadline — affects a person’s weight, behavior and physiology.

During the first week of the study, half the people were allowed to sleep nine hours a night while the other half stayed up until about midnight and then could sleep up to five hours. Everyone was given unlimited access to food. In the second week, the nine-hour sleepers were then restricted to five hours of sleep a night, while the sleep-deprived participants were allowed an extra four hours.

Notably, the researchers found that staying up late and getting just five hours of sleep increased a person’s metabolism. Sleep-deprived participants actually burned an extra 111 calories a day, according to the findings published last week in The Proceedings of the National Academy of Sciences.

But even though we burn more calories when we stay awake, losing sleep is not a good way to lose weight. The light sleepers ended up eating far more than those who got nine hours of sleep, and by the end of the first week the sleep-deprived subjects had gained an average of about two pounds.

During the second week, members of the group that had originally slept nine hours also gained weight when they were restricted to just five hours. And the other group began to lose some (but not all) of the weight gained in that first sleep-deprived week.

Kenneth Wrightdirector of the university’s sleep and chronobiology laboratory, said part of the change was behavioral. Staying up late and skimping on sleep led to not only more eating, but a shift in the type of foods a person consumed.

“We found that when people weren’t getting enough sleep they overate carbohydrates,” he said. “They ate more food, and when they ate food also changed. They ate a smaller breakfast and they ate a lot more after dinner.”

In fact, sleep-deprived eaters ended up eating more calories during after-dinner snacking than in any other meal during the day. Over all, people consumed 6 percent more calories when they got too little sleep. Once they started sleeping more, they began eating more healthfully, consuming fewer carbohydrates and fats. Dr. Wright noted that the effect of sleep deprivation on weight would likely be similar in the real world although it might not be as pronounced as in the controlled environment. The researchers found that insufficient sleep changed the timing of a person’s internal clock, and that in turn appeared to influence the changes in eating habits. “They were awake three hours before their internal nighttime had ended,” Dr. Wright said. “Being awakened during their biological night is probably why they ate smaller breakfasts.”

The effect was similar to the jet lag that occurs when a person travels from California to New York.

Last fall, The Annals of Internal Medicine reported on a study by University of Chicago researchers, who found thatlack of sleep alters the biology of fat cells. In the small study — just seven healthy volunteers — the researchers tracked the changes that occurred when subjects moved from 8.5 hours of sleep to just 4.5 hours. After four nights of less sleep, their fat cells were less sensitive to insulin, a metabolic change associated with both diabetes and obesity.

“Metabolically, lack of sleep aged fat cells about 20 years,” said Matthew Brady, an associate professor of medicine at the University of Chicago and the senior author on the study.

“These subjects were in their low 20s but it’s as if they were now middle-aged in terms of their response. We were surprised how profound the effects were.”

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http://well.blogs.nytimes.com/2013/03/18/lost-sleep-can-lead-to-weight-gain/?hp

On building resilience by hearing and knowing the family story

Building resilience in children and families is a kind of Holy Grail for healthy families. A simple but powerful tool, may be to hear and internalize the family stories. How a child fits into the larger intergenerational narrative. Feiler quotes Marshall Duke out of Emory who has formally studied the power of resilience and the family narrative. What  a fun way to build resilience! 

THIS LIFE

The Stories That Bind Us

Sarah Williamson

Families may want to create a mission statement similar to the ones many companies use to identify their core values.

By BRUCE FEILER

Published: March 17, 2013

I hit the breaking point as a parent a few years ago. It was the week of my extended family's annual gathering in August, and we were struggling with assorted crises. My parents were aging; my wife and I were straining under the chaos of young children; my sister was bracing to prepare her preteens for bullying, sex and cyberstalking.

Sure enough, one night all the tensions boiled over. At dinner, I noticed my nephew texting under the table. I knew I shouldn't say anything, but I couldn't help myself and asked him to stop.

Ka-boom! My sister snapped at me to not discipline her child. My dad pointed out that my girls were the ones balancing spoons on their noses. My mom said none of the grandchildren had manners. Within minutes, everyone had fled to separate corners.

Later, my dad called me to his bedside. There was a palpable sense of fear I couldn't remember hearing before.

"Our family's falling apart," he said.

"No it's not," I said instinctively. "It's stronger than ever."

But lying in bed afterward, I began to wonder: Was he right? What is the secret sauce that holds a family together? What are the ingredients that make some families effective, resilient, happy?

It turns out to be an astonishingly good time to ask that question. The last few years have seen stunning breakthroughs in knowledge about how to make families, along with other groups, work more effectively.

Myth-shattering research has reshaped our understanding of dinnertime, discipline and difficult conversations. Trendsetting programs from Silicon Valley and the military have introduced techniques for making teams function better.

The only problem: most of that knowledge remains ghettoized in these subcultures, hidden from the parents who need it most. I spent the last few years trying to uncover that information, meeting families, scholars and experts ranging from peace negotiators to online game designers to Warren Buffett's bankers.

After a while, a surprising theme emerged. The single most important thing you can do for your family may be the simplest of all: develop a strong family narrative.

I first heard this idea from Marshall Duke, a colorful psychologist at Emory University. In the mid-1990s, Dr. Duke was asked to help explore myth and ritual in American families.

"There was a lot of research at the time into the dissipation of the family," he told me at his home in suburban Atlanta. "But we were more interested in what families could do to counteract those forces."

Around that time, Dr. Duke's wife, Sara, a psychologist who works with children with learning disabilities, noticed something about her students.

"The ones who know a lot about their families tend to do better when they face challenges," she said.

Her husband was intrigued, and along with a colleague, Robyn Fivush, set out to test her hypothesis. They developed a measure called the "Do You Know?" scale that asked children to answer 20 questions.

Examples included: Do you know where your grandparents grew up? Do you know where your mom and dad went to high school? Do you know where your parents met? Do you know an illness or something really terrible that happened in your family? Do you know the story of your birth?

Dr. Duke and Dr. Fivush asked those questions of four dozen families in the summer of 2001, and taped several of their dinner table conversations. They then compared the children's results to a battery of psychological tests the children had taken, and reached an overwhelming conclusion. The more children knew about their family's history, the stronger their sense of control over their lives, the higher their self-esteem and the more successfully they believed their families functioned. The "Do You Know?" scale turned out to be the best single predictor of children's emotional health and happiness.

"We were blown away," Dr. Duke said.

And then something unexpected happened. Two months later was Sept. 11. As citizens, Dr. Duke and Dr. Fivush were horrified like everyone else, but as psychologists, they knew they had been given a rare opportunity: though the families they studied had not been directly affected by the events, all the children had experienced the same national trauma at the same time. The researchers went back and reassessed the children.

"Once again," Dr. Duke said, "the ones who knew more about their families proved to be more resilient, meaning they could moderate the effects of stress."

Why does knowing where your grandmother went to school help a child overcome something as minor as a skinned knee or as major as a terrorist attack?

"The answers have to do with a child's sense of being part of a larger family," Dr. Duke said.

Psychologists have found that every family has a unifying narrative, he explained, and those narratives take one of three shapes.

First, the ascending family narrative: "Son, when we came to this country, we had nothing. Our family worked. We opened a store. Your grandfather went to high school. Your father went to college. And now you. ..."

Second is the descending narrative: "Sweetheart, we used to have it all. Then we lost everything."

"The most healthful narrative," Dr. Duke continued, "is the third one. It's called the oscillating family narrative: 'Dear, let me tell you, we've had ups and downs in our family. We built a family business. Your grandfather was a pillar of the community. Your mother was on the board of the hospital. But we also had setbacks. You had an uncle who was once arrested. We had a house burn down. Your father lost a job. But no matter what happened, we always stuck together as a family.' "

Dr. Duke said that children who have the most self-confidence have what he and Dr. Fivush call a strong "intergenerational self." They know they belong to something bigger than themselves.

Leaders in other fields have found similar results. Many groups use what sociologists call sense-making, the building of a narrative that explains what the group is about.

Jim Collins, a management expert and author of "Good to Great," told me that successful human enterprises of any kind, from companies to countries, go out of their way to capture their core identity. In Mr. Collins's terms, they "preserve core, while stimulating progress." The same applies to families, he said.

Mr. Collins recommended that families create a mission statement similar to the ones companies and other organizations use to identify their core values.

The military has also found that teaching recruits about the history of their service increases their camaraderie and ability to bond more closely with their unit.

Cmdr. David G. Smith is the chairman of the department of leadership, ethics and law at the Naval Academy and an expert in unit cohesion, the Pentagon's term for group morale. Until recently, the military taught unit cohesion by "dehumanizing" individuals, Commander Smith said. Think of the bullying drill sergeants in "Full Metal Jacket" or "An Officer and a Gentleman."

But these days the military spends more time building up identity through communal activities. At the Naval Academy, Commander Smith advises graduating seniors to take incoming freshmen (or plebes) on history-building exercises, like going to the cemetery to pay tribute to the first naval aviator or visiting the original B-1 aircraft on display on campus.

Dr. Duke recommended that parents pursue similar activities with their children. Any number of occasions work to convey this sense of history: holidays, vacations, big family get-togethers, even a ride to the mall. The hokier the family's tradition, he said, the more likely it is to be passed down. He mentioned his family's custom of hiding frozen turkeys and canned pumpkin in the bushes during Thanksgiving so grandchildren would have to "hunt for their supper," like the Pilgrims.

"These traditions become part of your family," Dr. Duke said.

Decades of research have shown that most happy families communicate effectively. But talking doesn't mean simply "talking through problems," as important as that is. Talking also means telling a positive story about yourselves. When faced with a challenge, happy families, like happy people, just add a new chapter to their life story that shows them overcoming the hardship. This skill is particularly important for children, whose identity tends to get locked in during adolescence.

The bottom line: if you want a happier family, create, refine and retell the story of your family's positive moments and your ability to bounce back from the difficult ones. That act alone may increase the odds that your family will thrive for many generations to come.

"This Life" appears monthly in Sunday Styles. This article is adapted from Bruce Feiler's recently published book, "The Secrets of Happy Families: How to Improve Your Morning, Rethink Family Dinner, Fight Smart, Go Out and Play, and Much More."

I try to always look for sleep related disorders, restless legs syndrome, snoring, straight forward sleep deprivation as concomitant as well as mimics of adhd. Sleep is a core task of childhood, and impacts mood , irritability, learning so profoundly. 


Attention Problems May Be Sleep-Related 
 http://well.blogs.nytimes.com/2012/04/16/attention-problems-may-be-sleep-related/

                               by KATE MURPHY, well.blogs.nytimes.com
April 16th 2012

Diagnoses of attention hyperactivity disorder among children have increased dramatically in recent years, rising 22 percent from 2003 to 2007, according to the Centers for Disease Control and Prevention. But many experts believe that this may not be the epidemic it appears to be.

Many children are given a diagnosis of A.D.H.D., researchers say, when in fact they have another problem: a sleep disorder, like sleep apnea. The confusion may account for a significant number of A.D.H.D. cases in children, and the drugs used to treat them may only be exacerbating the problem.

“No one is saying A.D.H.D. does not exist, but there’s a strong feeling now that we need to rule out sleep issues first,” said Dr. Merrill Wise, a pediatric neurologist and sleep medicine specialist at the Methodist Healthcare Sleep Disorders Center in Memphis.

The symptoms of sleep deprivation in children resemble those of A.D.H.D. While adults experience sleep deprivation as drowsiness and sluggishness, sleepless children often become wired, moody and obstinate; they may have trouble focusing, sitting still and getting along with peers.

The latest study suggesting a link between inadequate sleep and A.D.H.D. symptoms appeared last month in the journal Pediatrics. Researchers followed 11,000 British children for six years, starting when they were 6 months old. The children whose sleep was affected by breathing problems like snoring, mouth breathing or apnea were 40 percent to 100 percent more likely than normal breathers to develop behavioral problems resembling A.D.H.D.

Children at highest risk of developing A.D.H.D.-like behaviors had sleep-disordered breathing that persisted throughout the study but was most severe at age 2 1/2.

“Lack of sleep is an insult to a child’s developing body and mind that can have a huge impact,” said Karen Bonuck, the study’s lead author and a professor of family and social medicine at Albert Einstein College of Medicine in New York. “It’s incredible that we don’t screen for sleep problems the way we screen for vision and hearing problems.”

Her research builds on earlier, smaller studies showing that children with nighttime breathing problems did better with cognitive and attention-directed tasks and had fewer behavioral issues after their adenoids and tonsils were removed. The children were significantly less likely than untreated children with sleep-disordered breathing to be given an A.D.H.D. diagnosis in the ensuing months and years.

Most important, perhaps, those already found to have A.D.H.D. before surgery subsequently behaved so much better in many cases that they no longer fit the criteria. The National Institutes of Health has begun a study, called the Childhood Adenotonsillectomy Study, to understand the effect of surgically removing adenoids and tonsils on the health and behavior of 400 children. Results are expected this year. .....

Why we are screening kids for cholesterol.

• Interestingly stress and sleep are identified as major risk factor(s).
• NEWS AND FEATURES

• Copyright © 2012 by the American Academy of Pediatrics

NHLBI guidelines on cholesterol in kids: What’s new and how does this change practice?

1. Sarah de Ferranti, M.D., M.P.H., FAAP and
2. Reginald L. Washington, M.D., FAAP

New guidelines from the National Heart, Lung and Blood Institute (NHLBI) on reducing cardiovascular disease (CVD) in children and adolescents provide many recommendations that are consistent with previous AAP and American Heart Association (AHA) statements. A few provisions, however, are new and/or controversial, including the following:

• All children should undergo cholesterol screening once between ages 9-11 years and once between ages 17-21 years.

• Non-fasting total cholesterol and high-density lipoprotein (HDL) can be used for the initial lipid screening test.

• Clinicians may recommend low-fat or no-fat dairy at age 1 year for high-risk patients.

• For patients who fail lifestyle changes and require lipid-lowering medications, pharmacologic treatment should be considered at age 10 years.

• Once low-density lipoprotein (LDL) is optimized, high non-HDL cholesterol may be targeted for residual CVD risk reduction.

GUIDELINES BASED ON EXTENSIVE REVIEW

The NHLBI released Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents (www.nhlbi.nih.gov/​guidelines/​cvd_ped/​) in November 2011. The report was endorsed by the Academy, and a summary was published in a supplement to Pediatrics,http:/​/​pediatrics.aappublications.org/​content/​early/​2011/​11/​09/​peds.2009-2107C.citation.

The guidelines present the results of an expert committee review of more than 1,000 published documents on CVD as it relates to children and adolescents. The guidelines cover a range of CVD risk domains; they grade the quality of evidence in pediatrics for the first time; and they can be integrated into the Bright Futures guidelines on pediatric health maintenance.

Dr. de Ferranti

Data are presented that clearly support a relationship between early exposure to CVD risk factors and atherosclerosis, including pathology studies and studies of vasculature dysfunction. In a single document, these guidelines raise consciousness about both genetic and obesity-related CVD risk.

Although the guidelines are comprehensive (400-plus pages in the full document), much of what is recommended already is part of general practice, e.g. measure body mass index, encourage breastfeeding, assess family history and counsel about healthy lifestyle.

GOALS OF UNIVERSAL SCREENING

The new recommendation with the most impact is to perform universal lipid testing (fasting or non-fasting) once between ages 9 and 11 years and again between 17 and 21 years. This is in addition to selective screening previously recommended by the Academy and AHA. The goal is to identify familial hyperlipidemias (FH), found in one in 300-500 children but asymptomatic until there is myocardial ischemia. Untreated individuals with FH have a risk of premature coronary heart disease up to 20 times greater than those without FH. One study suggests that statin therapy can reduce the risk of cardiac events in FH to that of the general adult population but only if identified early.

In addition to the genetic LDL lipid disorders, universal lipid screening is likely to identify many more children with lipid abnormalities that require lifestyle modification. Data from the National Health and Nutrition Examination Survey suggest one in five U.S. adolescents has some type of lipid disorder (Centers for Disease Control and Prevention. MMWR2010;59(2):29-33).

Dr. Washington

The guidelines focus on lifestyle modification for the first six months in nearly all patients. Much of the initial management of identified CVD risk factors can be done in a primary care setting if nutrition support and lifestyle counseling are available. When lifestyle modifications fail to reduce the lipids to the desired level in patients with extreme lipid disorders, pharmacotherapy is recommended. Some fear this recommendation will lead to an avalanche of statin prescriptions for children. This fear probably is unfounded, based on the low prevalence of extremely elevated LDL, which is about 1% of the population.

In addition, the guidelines recommend initiating lipid-lowering medications in patients meeting criteria starting at age 10 years, whereas the 2008 AAP clinical report Lipid Screening and Cardiovascular Health in Childhood (http:/​/​aappolicy.aappublications.org/​cgi/​content/​full/​pediatrics;122/​1/​198) put more emphasis on age 8 years. Published data support clinical experience that in the short and medium term, lipid-lowering medications are well-tolerated and safe for the few patients who need them.

LIMITATIONS

These guidelines have some limitations. Emerging data suggest additional CVD risk factors such as early excess adiposity detected using weight for length in infants, inadequate sleep and high stress.

In addition, long-term safety and efficacy data on statins in childhood are not available, although adult studies support low side effects and reduced overall mortality.

Importantly, the burden of the guidelines on patients, families, providers and the health care system has yet to be explored.

• Dr. de Ferranti is a member of the AAP Committee on Nutrition. Dr. Washington is a member of the AAP Section on Cardiology and Cardiac Surgery.

Related article in AAP News: