Playground-Related Brain Injuries on Rise in U.S.

By Kathleen Doheny
HealthDay Reporter

MONDAY, May 2, 2016 (Healthday News) — For some kids, playgrounds aren’t all fun and games. Playground-related brain injuries have risen significantly in the United States over the last decade, health officials say.

Despite improvements in playground safety and design, between 2001 and 2013, emergency rooms treated an average of 21,000 playground-related traumatic brain injuries annually among kids 14 and younger.

The statistics were compiled for a new report from the U.S. Centers for Disease Control and Prevention.

“It’s not just sports. This study highlights the importance of other causes of traumatic brain injuries and concussion among children,” said study researcher Dr. Jeneita Bell. She is a medical officer at the CDC’s National Center for Injury Prevention and Control.

The researchers can’t explain why serious head injuries are increasing. “We can only make assumptions,” Bell said.

“It may be that there is increased awareness about concussions as a whole,” she suggested. In recent years, researchers have focused on the dangers of concussions among children, especially in sports.

Monkey bars, playground gyms and swings were the pieces of equipment cited most often in connection with these head injuries. And about two-thirds of the injuries occurred at schools and recreational sports facilities, according to the study.

Th researchers looked at national injury-surveillance data and found that ERs treated more than 29,000 children for concussions and other serious head injuries in 2013, up from 18,000 in 2001. The numbers started rising notably in 2009, the study authors said.

Boys accounted for nearly six out of 10 of these ER visits. And more than half of the children treated were aged 5 to 9, Bell’s team found. Most of the injuries happened in April, May and September.

In recent years, industry standards for playgrounds have improved, with surfacing better able to reduce the risk of injury and death from falls, the researchers said, suggesting even better safety strategies are needed.

The study findings don’t surprise Dr. Barbara Pena, research director of the emergency department at Nicklaus Children’s Hospital in Miami. She, too, cited increased awareness of the dangers of head injuries as one probable reason for the uptick.

Adult supervision is crucial to reduce the injury rate, agreed Pena and Bell. Pena also suggested recognizing that some pieces of equipment are more hazardous than others.

“I would advise them to stay away from the monkey bars,” Pena said. If that’s not possible, parents and teachers should warn children that hanging upside down from monkey bars is dangerous, because they’ll likely land on their head if they fall, she added.

Parents should also inspect playgrounds.

“Check the surfacing to make sure there is soft surfacing in place,” Bell said. Be sure your child is playing on equipment appropriate for his or her age. And, look at the equipment to be certain it’s in good condition, Bell advised.

The study should not discourage playground use, Pena said. “It’s fun and it’s needed, and kids can be outside,” she said. But paying attention to the equipment and the supervision can go a long way to reducing injuries, the experts agreed.

The study results were published online May 2 in the journal Pediatrics.

More information

To learn more about playground safety, visit the National Program for Playground Safety.

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Bullying Can Turn Victims Into Bullies

SATURDAY, April 30, 2016 (HealthDay News) — A combination of face-to-face taunting and cyberbullying may greatly increase the risk that victims will become bullies themselves, a new study suggests.

“Students who are victimized are more likely to exhibit aggressive behaviors towards others,” said study principal investigator Alexandra Hua, from Cohen Children’s Medical Center of New York. “This phenomenon may lead to a vicious cycle whereby bullies create bullies out of those they victimize.”

In the study, researchers analyzed data from U.S. students aged 10 to 17. The investigators found that 43 percent of the children had experienced face-to-face bullying and 7 percent had been subjected to some form of cyberbullying through text messages, social media and other means.

Kids who experienced either in-person or online bullying were more likely to display aggressive behaviors, such as physical fighting, verbal hostility, property damage and peer coercion, the findings showed.

But the risk of those behaviors was more than twice as high among victims of both types of bullying, the study authors said.

Of the kids who experienced both forms of bullying, 38 percent showed aggressive behavior. This compared with 15 percent of those who were cyberbullied and 4 percent of those who were victims of face-to-face bullying alone.

The findings were scheduled for presentation Saturday at the Pediatric Academic Societies annual meeting, in Baltimore.

The results are concerning, but not surprising, study senior investigator Dr. Andrew Adesman said in an American Academy of Pediatrics news release.

“These behaviors may involve retaliatory measures against their aggressors, acting aggressive in order to fend off future bullying attempts, or worse, learning by example and engaging in bullying of previously uninvolved peers,” Adesman said. He is chief of developmental and behavioral pediatrics at Cohen Children’s Medical Center of New York.

Hua also noted that with the high rates of mobile device use by young people, there should be greater focus on cyberbullying and its harm, especially when combined with face-to-face bullying.

Research presented at meetings should be viewed as preliminary until published in a peer-reviewed journal.

More information

The U.S. Department of Health and Human Services has more on bullying.

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Kids With Two Dads as Well-Adjusted as Other Kids, Study Finds

SATURDAY, April 30, 2016 (HealthDay News) — Children of gay fathers are as well-adjusted as kids of heterosexual parents, a new survey finds.

Roughly 31,000 male couples are raising children in the United States, and little is known about the well-being of those kids, the researchers said.

“Because stigma continues to interfere with the efforts of gay men to become parents and with the lives of gay men and their children, our research underscores the need for social and legal protections for families headed by same-sex parents,” said principal investigator Dr. Ellen Perrin.

Perrin is director of research for the Center for Children With Special Needs at the Floating Hospital for Children at Tufts Medical Center, in Boston.

She and her colleagues analyzed responses from 732 gay fathers in 47 states who took part in an online survey. They were asked about their children’s well-being, including school performance, self-esteem and friendships.

The gay fathers’ responses were nearly identical to those of parents in a national general survey. For example, 88 percent of gay fathers and 87 percent of those in the general survey said their child was not unhappy or depressed. And, 72 percent of gay fathers and 75 percent of parents in the general survey said their child does not worry a lot.

Thirty-six percent of the children in gay families were born when the fathers were in a heterosexual relationship, 38 percent were adopted or fostered, and 14 percent were carried by a surrogate, the researchers found.

But many of the gay fathers said they faced barriers to sharing custody, adopting and using a surrogate carrier.

Twenty to 30 percent of gay fathers said they had faced stigma for being a gay father, mainly from family, friends and some people in religious settings. One-third of gay fathers said their children had experienced teasing, bullying or other stigma from friends.

“Our data add to those of other investigators showing that children of same-sex parents do as well in every way as children whose parents are heterosexual,” Perrin said in an American Academy of Pediatrics news release.

The study findings are to be presented Sunday at the annual meeting of the Pediatric Academic Societies, in Baltimore. Because the data and conclusions haven’t undergone peer review, they should be considered preliminary.

More information

The American Academy of Pediatrics offers advice for gay and lesbian parents.

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Autism Diagnosed at Younger Ages

SATURDAY, April 30, 2016 (HealthDay News) — Children are being diagnosed with autism at younger ages since the American Academy of Pediatrics (AAP) made changes to their diagnosis guidelines in 2007, a new study says.

The AAP guidelines now advise doctors to screen all children for autism during well-child visits when children are 18 months and 24 months old. By screening all children, those who have the condition can receive early treatment, researchers said.

To see if that change made a difference, researchers compared children diagnosed with autism between 2003 and 2012 at a center in New York City. Among children born before 2005, the average age of diagnosis was just under 4 years. The average age at diagnosis for kids born after 2005 was about 2.5 years, the study found.

“Our research shows that children evaluated before the AAP recommended universal pediatric screening were more likely to be diagnosed at an older age and with more severe autistic symptoms and more impaired adaptive functioning,” lead author Dr. Maria Valicenti-McDermott said in an AAP news release. She’s an attending physician at the Children’s Evaluation and Rehabilitation Center at Montefiore Health System, in New York City.

The researchers noted that it’s not clear if the increase in younger children being diagnosed is a direct result of the AAP guideline change. It’s also possible that an increase in general autism awareness may have played a significant role.

The findings are scheduled to be presented Sunday at the Pediatric Academic Societies meeting, in Baltimore. Studies presented at meetings are typically viewed as preliminary until they’ve been published in a peer-reviewed journal.

Children in all racial and ethnic groups are being diagnosed at earlier ages, the research showed. Valicenti-McDermott said this is important because black and Hispanic children have often been diagnosed with autism later, which can lead to worse outcomes.

Not everyone agrees with the new guidelines. Earlier this year, the U.S. Preventive Services Task Force said there wasn’t enough evidence to recommend universal autism screening of young children when no concerns of autism have been raised by their parents or health care provider.

More research is needed to confirm the effectiveness of universal autism screening, Valicenti-McDermott said.

“But given the undisputed benefit of early identification of autism, sorting out the contribution of universal screening to this pattern will be an important next step to address the concerns of the U.S. Preventive Services Task Force regarding the benefits of early screening,” she said.

More information

The National Alliance on Mental Illness has more about autism.

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‘Wandering’ a Hazard for More Than a Third of Kids With Autism

SATURDAY, April 30, 2016 (HealthDay News) — Discovering that a child with autism has wandered away from the safety of home would be a terrifying moment for any parent.

Now, a new study reports that one-third of children on the autism spectrum engage in wandering behaviors.

“Wandering places children with autism spectrum disorders at risk of serious injury or even death once they are away from adult supervision,” study senior investigator Dr. Andrew Adesman said in a Northwell Health news release. Adesman is chief of developmental pediatrics at Cohen Children’s Medical Center (CCMC) of New York.

His team tracked the histories of more than 1,400 children, aged 6 to 17, with autism. The researchers found that more than one-third had wandered from a safe setting within the past 12 months.

Kids who wandered were more likely to be unaware of when they are in danger, and to have trouble distinguishing between strangers and familiar people, the study found. In addition, these kids were also more prone to sudden mood changes, to over-react to situations and people, to get angry quickly, and to panic in new situations or if faced with change, the researchers said.

Wandering was twice as likely to occur when the children were in a public place — for example a mall or street — than from home or school, Adesman’s team found.

Principal investigator Bridget Kiely said in the news release, “As the prevalence of autism spectrum disorders in the United States continues to rise, there is a need to better understand the behaviors that may compromise the safety and well-being of these children.” Kiely is a research assistant in the division of developmental and behavioral pediatrics at CCMC.

There is also an urgent need to find more effective ways to prevent children with autism from wandering, the researchers said.

The study findings were scheduled to be presented Saturday at the Pediatric Academic Societies annual meeting, in Baltimore.

More information

The National Alliance on Mental Illness has more about autism.

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More U.S. Kids Have Chronic Health Problems: Study

By Steven Reinberg
HealthDay Reporter

SATURDAY, April 30, 2016 (HealthDay News) — The number of American kids suffering from asthma and attention deficit hyperactivity disorder (ADHD) is on the increase, with poor children being hit the hardest, researchers report.

Children living in extreme poverty who had asthma and ADHD were nearly twice as likely to have at least one other chronic medical condition. These conditions included developmental delays, autism, depression, anxiety, behavioral or conduct issues, speech and language problems, epilepsy and other seizure disorders, and learning disabilities.

“These findings emphasize the importance of studying poverty and its impact on child health, as well as confirm the need for increased awareness to inform child health policy,” said lead researcher Dr. Christian Pulcini, a resident at Children’s Hospital of Pittsburgh.

The reasons for the increase in chronic conditions aren’t clear, but access to health care and health literacy may be playing a part, he said. Increases in these conditions also were seen among children who rely on public assistance for their health care, Pulcini added.

“I like to think we are doing a better job with access to care and diagnosis, but I don’t know of any data that states that definitively,” he said.

“I also think the health literacy of the population is slowly improving, and programs such as Early Intervention and school-based services in individual states are working with parents to ensure they are aware of health concerns such as learning disabilities, speech and language disorders, ADHD, etcetera,” Pulcini said.

“This is all speculation, however, as our data only identifies the trends and not any causal factors,” he added.

The findings were to be presented Sunday at the Pediatric Academic Societies annual meeting, in Baltimore. Research presented at meetings should be viewed as preliminary because it has not undergone the rigorous process of peer review that most medical journals require.

For the study, Pulcini and his colleagues analyzed data from the National Survey of Children’s Health for 2003, 2007, 2011 and 2012, looking for trends in asthma, ADHD and economic status.

They found more significant increases in asthma and ADHD cases among children living in poverty, compared with their wealthier counterparts. Poor children with these conditions also were more likely to suffer from two or more additional conditions.

“I would like to think it could all be attributed to better identification and diagnosis, but, at least in my experience, there are still many children of families with limited means who have poor access to regular care who may not have their primary or additional health conditions identified correctly,” Pulcini said.

Dr. Jefry Biehler, chairman of pediatrics at Nicklaus Children’s Hospital in Miami, said he wasn’t surprised by the findings.

“We continue to see that chronic conditions unevenly affect the poor and the underserved more than the those who are not poor and receive more frequent health care,” he said.

Expanded Medicaid services under the Affordable Care Act should help by providing better access to care for thousands of children, Biehler added.

“We need to face these issues head on and try to prevent or manage these chronic conditions early on so that outcomes will be much better, both for the individuals and society,” he said.

More information

Visit the U.S. Centers for Disease Control and Prevention for more on health care for children.

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Study Suggests Aerial Pesticide Spraying Tied to Higher Autism Rates

By Amy Norton
HealthDay Reporter

SATURDAY, April 30, 2016 (HealthDay News) — Children living in an area of New York state that uses aerial pesticides to control mosquitoes have a higher rate of autism than children in neighboring areas, a new study finds.

Researchers found that children living in a swampy region in central New York were 25 percent more likely to have been diagnosed with autism or general developmental delay, compared to children in other parts of the state.

However, the findings do not prove that aerial pesticides raise the risk of autism, stressed lead researcher Dr. Steven Hicks, a pediatrician at Penn State Milton S. Hershey Medical Center, in Hershey, Pa.

“This study really brings up more questions than answers,” he said. “We need more research before taking any public action on pesticide use.”

One reason for restraint, Hicks noted, is that communities spray for mosquitoes to help prevent potentially severe mosquito-borne diseases, such as West Nile virus.

Still, the study isn’t the first to find a possible link between pesticides and autism rates, Hicks said.

He pointed to a study that made the news two years ago. California researchers found that pregnant women who lived within a mile of pesticide-treated crops were slightly more likely to have a child with autism, compared to women who lived farther from the treated fields.

The implicated chemicals in the California study belonged to a group known as pyrethroid pesticides, Hicks noted.

Hicks is scheduled to present findings from the new study Saturday at the annual meeting of the Pediatric Academic Societies, in Baltimore. Findings from meetings are generally viewed as preliminary until published in a peer-reviewed journal.

An estimated one in 68 U.S. children has been diagnosed with an autism spectrum disorder (ASD), according to the U.S. Centers for Disease Control and Prevention.

ASD refers a group of developmental brain disorders that affect children’s behavior and the ability to communicate and socialize. Symptoms range widely in severity: Some kids have relatively mild problems with social interactions. Others are unable to speak and focus on a limited number of repetitive behaviors, the CDC says.

Hicks said he and his colleagues were interested in whether the method of applying pyrethroid pesticides might be related to autism rates.

To do so, they looked at autism diagnoses among children at pediatric clinics in two New York state areas: eight zip codes within a swampy area where officials used aerial spraying of pyrethroid pesticides to control mosquitoes, and 16 zip codes that used different methods to apply pesticides, such as using hoses or manually spreading granules.

In the area with aerial spraying, Hicks said, one in 120 children was diagnosed with an autism spectrum disorder or developmental delay. The prevalence in areas without aerial spraying was one in 172, he said.

After the researchers accounted for factors such as local poverty levels and preterm birth rates, children in the zip codes with aerial spraying were still one-quarter more likely to have been diagnosed with an ASD, the study revealed.

“That suggests it’s not just the type of pesticide or the timing of exposure, but the mode of application that matters,” Hicks said.

However, he stressed, there could be other explanations for the link. And it’s not clear whether the children’s mothers lived in those zip codes during pregnancy — a “big limitation” of the study, Hicks said.

Dr. Paul Wang is head of medical research for the nonprofit Autism Speaks. If pesticide exposure contributes to autism risk, it would most likely be during fetal development — not childhood, he said.

And while a few studies have now found correlations between pesticides and autism risk, that doesn’t prove cause-and-effect, Wang said.

It’s also unclear whether there is anything special about aerial spraying, Wang pointed out. In this study, zip codes with aerial spraying also had higher levels of total pesticide exposure.

In general, Wang said, experts believe autism arises from an “interplay of genes and environment.” Researchers have found a number of genes associated with autism risk, and children with an affected older sibling are at higher-than-average risk.

Hicks made the same point. It’s thought that genes make some kids more vulnerable to autism, but they also need to be exposed to certain environmental factors during critical windows of early brain development for the disorder to emerge.

It’s not clear what those factors are, but some suspects include prenatal exposure to poor nutrition, certain infections and heavy air pollution, according to Autism Speaks.

For now, Wang suggested that expectant moms focus on good nutrition, regular prenatal care and other steps to help ensure they have as healthy a pregnancy as possible.

More information

Autism Speaks has advice on avoiding toxic exposures during pregnancy.

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Seniors’ Worsening Depression May Sometimes Predict Dementia

FRIDAY, April 29, 2016 (HealthDay News) — In some cases, worsening symptoms of depression in seniors might point to early dementia, a new study suggests.

The Dutch study can’t prove cause-and-effect, and certainly not every depressed senior is headed for dementia. But experts said the findings are intriguing.

“More research is needed, but the study raises the possibility of an overlap between the pathology of dementia and depression,” said Dr. Gisele Wolf-Klein, who reviewed the findings. She directs geriatric education at Northwell Health in New Hyde Park, N.Y.

The study was led by Dr. M Arfan Ikram, an epidemiologist at Erasmus University Medical Center in Rotterdam. His team tracked depression symptoms in more than 3,300 adults, aged 55 and older, in the Netherlands for 11 years. The patients were then monitored for signs of dementia for another 10 years.

During that follow-up, 434 of the participants developed dementia, including 348 cases of Alzheimer’s disease. Only those whose symptoms of depression increased over time were at increased risk for dementia, Ikram’s team found.

And not everyone in that group developed dementia: Only about 22 percent did so, the researchers said.

Still, that number was higher than for people who had a low level of symptoms of depression — only 10 percent in that group went on to develop dementia, the study found. That rate was similar for those with remitting (coming and going) symptoms of depression.

According to the research team, the findings suggest that having temporary depression — even if severe — does not have a lasting effect on the risk of dementia.

However, Ikram’s group believes that increasing symptoms of depression in older adults could be reflective of an early stage of dementia in some cases. They say the finding supports prior research suggesting that dementia and certain types of depression may have a common cause.

Wolf-Klein agreed. “Different courses of depression may reflect different underlying causes, and might be linked to different risks of dementia,” she theorized.

Dr. Aaron Pinkhasov is chair of behavioral health at Winthrop-University Hospital in Mineola, N.Y. He called the research “the first robust study looking into the very important association between depression and dementia.”

Pinkhasov believes the findings point to a possible common cause between the underpinnings of some cases of depression and dementia.

The study “raises extremely important questions about the role of depression screening and treatment in mitigating the risk of dementia development,” he said.

The study was published April 29 in The Lancet Psychiatry.

More information

The U.S. National Institute of Neurological Disorders and Stroke has more on dementia.

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