Category Archives: Science

Crying baby to parents: Speed it up!

Waaaah!

From Oxford University:

A baby’s cry actually speeds up an adult’s response to whatever task is at hand. The Oxfordians timed adult subjects playing “Whack-A-Mole,” the old arcade game, while listening either to crying babies, stressed-out adult noises, or twittering birds. As you may have guessed from personal parenting experience, the crying babies sped up the subjects’ mole-whacking speed.

“Few sounds provoke a visceral reaction quite like the cry of a baby,” said Oxford psychiatrist Morten Kringelbach. “For example, it’s almost impossible to ignore crying babies on planes…despite all the other noises and distractions around.”

The findings make evolutionary sense. In prehistoric times, babies who got their needs met quickly were more likely to survive childhood.

The Oxford team isn’t just playing games–they’re looking into the possibility that women with postpartum depression may suffer from a disruption of this ancient response to a baby’s cry.

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Filed under Newborns, Science

Obituary: Mary Ellen Avery, M.D.

Mary Ellen Avery, M.D. (1927-2011)

The work of Dr. Mary Ellen Avery, who died December 4th, is well-known to anyone who has worked in an intensive care nursery in the last 50 years. Her career was studded with a long list of “firsts”–first woman to be appointed physician in chief at Children’s Hospital Boston; first woman to head a clinical department at Harvard Medical School; first pediatrician to head the American Association for the Advancement of Science, etc., etc.–but she is best known for a discovery that to date has saved nearly a million premature babies.

In the early 1960s, Avery and her colleagues unravelled the mystery of why so many premature babies died of respiratory distress syndrome (or hyaline membrane disease, as it was known then). She and her team were the first to recognize that it was the absence of something, rather than an excess of something else, that caused babies’ lungs to collapse and kill them. That absent something was surfactant, a slippery mix of fat and proteins that coats the breathing tubes of healthy term babies and helps their lungs stay inflated.

Building on her research, a team of Japanese researchers revolutionized the care of premature newborns when they developed a surfactant replacement from cow lungs. In the early 1960s, 15,000 babies a year died from respiratory distress syndrome; by 2002 fewer than 1,000 did.

All of this came too late for my brother, James Bernard Sloan. Born eight weeks early in 1948, he died at two days of age from a lack of surfactant. (I wrote about James’s brief life in my book, Birth Day. It was the mystery of his death, which happened five years before I was born, that first got me interested in caring for sick babies.)

Had he been born twenty-five years later, James Bernard would have been an easy “save,” thanks to Mary Ellen Avery’s work.

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Childhood stress, adult disease: The ACE study

Stress: Very bad for a child's health.

One of the topics I’ll be focusing on in 2012 is the role that early childhood stress plays in the development of disease later in life.

This is a relatively new and fascinating corner of the research world, with the original research being performed by Drs. Vincent Felitti and Robert Anda, who demonstrated the link between adverse childhood events (ACEs, as they’re commonly known) and chronic health issues in adulthood in the 1990s.

Felitti and Anda studied seven categories of adverse childhood experiences: psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned. The results of their 1998 study, which involved 9,300 southern California Kaiser Permanente patients, were startling:

“Persons who had experienced four or more categories of childhood exposure [ie, adverse childhood events], compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, ≥50 sexual intercourse partners, and sexually transmitted disease; and a 1.4- to 1.6-fold increase in physical inactivity and severe obesity.”

In a number of follow-up studies the relationship has held true, and recent advances in neuroscience have helped to explain the link. So how do ACEs lead to later chronic illness? Why do some people emerge from traumatic childhoods largely unscathed, while others succumb to drug abuse and violence? And most importantly, what can be done to lessen the effects of ACEs on a child’s future health?

Those are subjects for future posts. In the meantime, here’s a link to a Salon interview with the authors of “Scared Sick: The Role of Childhood Trauma in Adult Disease”, a new book on the subject. The Q and A with the authors is worth a read.

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Filed under Cancer, Child abuse, Obesity, Science

Breaking science news: Tantrum-ing toddlers are angry. (No, really.)

Dr. Michael Potegal and his research team at the University of Minnesota have discovered that toddlers having tantrums are angry and sad at the same time, rather than, as the conventional wisdom would have it (at least in Minnesota), that anger comes first during a tantrum, followed by sadness.

They discovered this by dressing toddlers in onesies with microphones sewn into them (the onesies, not the toddlers). Once at home the parents pressed a “go” button and waited. Sooner or later some perceived injustice would lead to a first-class meltdown, and researchers were rewarded with a high-quality audio recording of the whole fit. After a hundred or so recordings, they found that the hubbub of a tantrum rises and fades in a definite pattern:

“Screaming and yelling and kicking often go together,” Potegal said. “Throwing things and pulling and pushing things tend to go together. Combinations of crying, whining, falling to the floor and seeking comfort — and these also hang together.”

Startling news, no?

The U of M team also discovered that trying to talk to a mid-tantrum toddler only tends to make things worse, which brings to mind this old Far Side cartoon by Gary Larson, in which you need only substitute the word “toddlers” for “dogs” to understand how much good it does to try to reason with a crazy-angry eighteen month-old.

Cross-species parenting tip from Gary Larson

There is a serious and possibly beneficial side to this research. By analyzing tantrums, Dr. Potegal and his colleagues hope someday to be able to distinguish those that are normal parts of development from those that may be warning signs of an underlying emotional disorder.

In the meantime, I often invoke the words of one of my pediatric attendings from the late 1970s in discussing tantrums with beleaguered parents. A veteran of five children of his own, he was a great believer in simply walking away from a screaming toddler.

“Think of a tantrum as a performance,” he told us. “If you want the play to close down, stop buying tickets.”

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Filed under Development, Science

Why I’m not a brain surgeon

Too late to do me any good now, but a study from the University of Notre Dame claims that children born at least two

I coulda been a somebody!

years apart are smarter than those born closer together. Something to do with there being only so many hours in a day, so parents stick Kid One in front of the TV while tending to Kid Two’s poop and spit-up. Then they collapse in an exhausted heap instead of teaching Kid One how to write symphonies. Or something.

My mother had the first four of us in four-and-a-half years (that’s three of Peg Sloan’s boys in the photo at top of this blog). My wife was the first of five kids in five years for her mother. My own kids are 19 months apart. And none of us writes symphonies, so there you have it.

Thanks a bunch, Mom…

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Now they tell me…

A new threat for parents: “Get outside and play or you’ll go blind!”

A study from England’s University of Cambridge finds that nearsighted children spend significantly less time playing outdoors than their normally-sighted pals. There wasn’t any difference in time spent doing “near work” (like homework) in either group, so the investigators conclude there’s something beneficial, eyesight-wise, to getting outside and playing.

Me? I grew up an air-conditioning-addicted kid in Evansville, Indiana, where the tar bubbled up out of the streets

Kids! Don't be like Dr. Sloan!!

from May to September, and showering in the summer was pointless–you were just going to be re-drenched in sweat ten minutes later, anyway. I spent most of the summer in my basement, reading or shooting rubber bands at my legion of plastic army guys.

And, apparently, ruining my vision. Got my glasses at 9, probably should have had them much earlier. If only I’d known then what I know now…

Nah, I’d have gone for the air conditioning anyway. Better to go blind than melt.

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Nice description of newborn vision

I’m always searching for well-written information for parents of newborns, particularly first-time parents. Here’s an excellent description of how well a newborn can see, from the Smith-Kettlewell Eye Research Insitute . Read this and you’ll see that a lot of information in pregnancy and parenting books is outdated.

Checking things out (in color, too).

Some highlights:

  • The idea that newborns can only see in black-and-white is wrong. Babies respond most readily to contrast, and black-and-white is all contrast. In fact, newborns can distinguish most colors, though their overall color vision isn’t as good as an adult’s. But they seem to prefer black-and-white toys because there’s not as much contrast between, say, blue and green as there is between black and white. (Plus, people keep sticking black-and-white toys in front of them…) Bottom line: brightly colored, contrast-y toys and mobiles are just as good.
  • Newborns are able to focus from a few inches away to the far distance. Their vision works best in-close because the visual area of the brain isn’t fully developed at birth. Within a few weeks it’s completely up to speed.
  • I now officially have crummier vision than a newborn. I was taught that newborn babies had 20/200 vision, identical to mine. Now I see they’ve been promoted to 20/120. Seems like cheating to me.

There’s a lot more, too. I’m adding this to the list of online parent resources I use in my practice.

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Filed under Newborns, Science

Overuse of CT scans in white kids with milder head injuries

Balancing risks and benefits

Interesting study out of the University of Michigan (my pediatric residency alma mater) this week: White kids being evaluated for head injuries in pediatric trauma center emergency rooms were significantly more likely to undergo a head CT scan than the African-American or Hispanic children seen in the same ER. Big study–over 40,000 visits.

Ah, but there’s a twist to this tale. This isn’t the usual sad story of underprivileged/under-insured kids getting substandard/lousy care: CT usage in cases of truly serious head injury was the same for all three groups. Which means that the increase in CT scans in white kids was seen only in cases of milder trauma…injuries that might not really have needed the scans in the first place.

So, what gives? Why would white children end up with more possibly unnecessary scans than other kids? The authors aren’t sure yet, but–I’m speculating here–defensive medicine and having insurance that’ll pay for the scans may well be part of the answer.

My main concern? That’s a lot of radiation for a young child’s brain to absorb. For kids with serious head injuries, it’s definitely worth the risk; for milder injuries, not so much.

If you’re in a science-wonky mood, here’s an article from the New England Journal of Medicine that explains CT scans and their radiation risks (see figure 3 in particular). If you’re all wonked out today, here’s the skinny: The younger the child, the greater the risk of developing later cancer from radiation exposure. Though the numbers have been questioned, it appears that as many as 6 to 8 infants out of every 1,000 who receive a single head CT may develop brain cancer down the road as a result. The risk decreases to less than 1 in 1,000 by the mid-teenage years. (Source: see figure 3 of the NEJM article).

Parents should feel comfortable questioning the need for a CT scan of any kind, even in an emergency room, and to have the risks and benefits of the scan laid out for them. Will the CT provide information that can’t be obtained by other means?

But please remember, there’s a time and place for all medical technology. Sometimes you really do need a CT scan.

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Filed under Cancer, Science

Abused chicks become abusing adults

Another one from the Science Times:

It’s almost a truism: abused children often grow up to be abusing adults. Now there’s evidence for this in nature.

Researchers writing in the October issue of The Auk, the journal of the American Ornithologists’ Union, studied Nazca boobies, ground-nesting birds native to the Galápagos Islands. The adults leave their chicks — they raise only one at a time — to forage for food, and often other adults approach the unguarded young. Almost all chicks have some contact with unrelated adults, which can be aggressive or sexual.

The researchers studied the birds over three breeding seasons, recording the numbers and types of interactions with unrelated adults of 24 banded nestlings. Then, during the 2004-5 season, another team of observers, unaware of the birds’ experiences as chicks, recorded the behavior of the same birds as adults interacting with unrelated nestlings. They found high correlations between the amount of aggressive behavior demonstrated by the adults and the amount of abuse they had endured as nestlings.

David J. Anderson, the senior author and a professor of biology at Wake Forest University, said that other studies had found increased levels of the stress hormone corticosterone in abused chicks, which may influence aggressive behavior later in life.

“It’s not just humans, and it’s not just a pathology associated with captivity,” Dr. Anderson said. “Maybe the cycle of violence is generalizable, and we may have other research models to work with in ways we can’t work with humans.”

The hormone response to stress in the Nazca booby chicks is the same seen in humans of any age. This adds to the growing body of evidence that physical and/or emotional stress on fetuses, infants, and children has lasting, often lifelong impact – even affecting the next generation and, probably, beyond. More on that in upcoming  posts.

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Filed under Child abuse, Science

Things I learned en route to looking up other things…

I dedicate this recurring feature to Sidney J. Harris (1917-86), a syndicated columnist who wrote for the Chicago Daily News back when I was in medical school. He was a wise man and a great writer, and among his proudest accomplishments was making Richard Nixon’s “master list” of enemies. My kind of guy.

Every so often he’d have a column titled “Things I Learned En Route to Looking Up Other Things.” It was a great potpourri of wry, interesting, often offbeat factoids that may or may not have been related to what he was researching. I’ll try to live up to his memory.

Today’s TILERTLUOT:

Estrogen was the first hormone. It’s over 500 million years old. All other steroid hormones – progesterone, testosterone, etc. – evolved from estrogen.

Now, before you go saying that “estrogen first” means women must have been around before men, consider this: in primitive fish, like the lamprey, estrogen directs the maturation of both sexes. That’s right…in the old, old days, estrogen put everyone in a mating frenzy. So there.

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Filed under Science, Things I learned en route to looking up other things