Category Archives: Science

FAQs: Is Vitamin D necessary for breastfed babies? (Part 1)

This is the first in a series of frequently asked questions I hear from parents in my practice. If you have an FAQ about children’s health, send it along!

Vitamin D: A buffness requirement

Is vitamin D supplementation really necessary for breastfed babies?

Vitamin D supplementation for breastfed newborns is a hot topic. Though it’s strongly recommended by the American Academy of Pediatrics, many parents understandably question the need for it. After all, isn’t breast milk nature’s perfect food? Aren’t we undermining breastfeeding promotion by saying mother’s milk is deficient in something? And, hey…if this is such a problem, how did the human race manage to get by without vitamin drops all these eons??

Let’s look at the issue from a number of angles and see what the fuss is all about. I’ll start with a basic Q & A and then go into more detail in future posts.

1) What is vitamin D?

Vitamin D is a steroid hormone. It belongs to the same chemical family as cholesterol, testosterone and estrogen, among many other compounds.

2) What does vitamin D do?

It was originally thought to only play a role in bone health, by helping the body absorb calcium. In recent years, though, vitamin D has been shown to play an important role in immune system functioning, both by heightening the body’s responses to invading bacteria and preventing the immune system from attacking normal tissues.

3) Where do we get vitamin D?

There are two major sources: sunlight and diet. Sunlight is the more efficient way to get vitamin D.

The good stuff

4) What happens if we don’t get enough?

Historically, the connection between lack of sunshine and rickets–soft, deformed bones–was made in the 19th century. (Pelvic bones shrunken and deformed by rickets were the cause of many deaths in childbirth in those days.) Later, a lack of vitamin D was identified as the cause of rickets. Osteoporosis, especially in women, also results from inadequate vitamin D. Recently, as vitamin D’s immune system role has become clearer, a lack of vitamin D has also been linked to a number of serious chronic conditions, such as Type 1 diabetes, systemic lupus erythematosis, and multiple sclerosis.

5) Why is there so much vitamin D deficiency these days?

It’s mainly due to decreased sun exposure and poor diet.

6) So why are breastfed babies at risk for vitamin D deficiency?

Many pregnant or lactating women don’t have enough vitamin D for their own bodies, let alone enough to build up their babies’ supply. A mother’s problem soon becomes her baby’s problem, too.

More to come…

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Filed under Nutrition, Science

Alison Gopnik on babies and “lantern consciousness”

Learning about baby brains

If you’re a fan of TED talks, here’s a short, interesting one by Alison Gopnik. She’s a professor of psychology at UC Berkeley and the author of popular books on how babies learn–most recently The Philosophical Baby (2009), which I reviewed for the San Francisco Chronicle. Her books make for fascinating reading, if you find babies as fascinating as I do.

In the Ted talk and in her book Gopnik describes infants and toddlers as having a “lantern consciousness” with which they explore their world. They take in everything around them–like a lantern casting light in all directions–without doing much editing. That maddening tendency to flit from thing to thing may drive parents nuts, but it’s purposeful flitting–it’s how they eventually make sense of everything, from social encounters to the physics of walking. (There’s a very cute video in the talk of a four-year old trying to figure out how to make a block light up–if nothing else, check that out.)

By comparison, Gopnik describes adults as having “spotlight consciousness”–we’re really good at zeroing in on the task at hand, at the expense of missing out on a lot of interesting things going on around us. We do occasionally flip into “lantern” mode, like when we travel to a new place and explore the differences between there and home (if we have time to just wander, that is). But most of the time we burrow into our familiar routines, focused on schedules and deadlines and racing through our chosen mazes. Too bad for us!

I like her description of what it’s like to be a lantern-conscious baby:

Pass the espresso!

“It’s like being in love in Paris for the first time after you’ve had three double espressos.”

Think of that image the next time you watch a baby hard at work, figuring out the world.

(And thanks to Erin Duckhorn for passing along the TED link!)

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Filed under Development, Science

For space-nuts of a certain age…

Monday is the 50th anniversary of John Glenn’s historic three-orbit space ride. That means it was probably fifty years ago tonight that I started worrying about him. I tossed and turned in bed, visions of catastrophe filling my eight year-old head: What if he can’t get back down? Could they send another rocket up to get him? How long would his food and water and oxygen last? Visions of poor John Glenn endlessly circling the earth, waiting to die, kept me wide awake.

He made it back, of course. We cheered in class when we heard he’d splashed down. Sister Margaret Jeanette even cried–a shocking sight for a room full of second-graders, since none of us knew nuns could cry. I slept like a baby that night.

Happy anniversary to John Glenn (and the rest of us astro-nuts).

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

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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Filed under Newborns, Obituaries, Science

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