Sunday, March 23, 2008

Food Additives cause Hyperactivity

EU Panel: 'Limited Evidence' Food Additives Cause Hyperactivity in Kids

Physician's First Watch for March 17, 2008

An analysis by the European Food Safety Authority downplays the significance of a Lancet study suggesting some synthetic food colors and sodium benzoate preservative cause hyperactivity in children.

The study, published in 2007, concluded that two mixtures of four synthetic colors and sodium benzoate increased hyperactivity in 3-year-olds and 8- to 9-year-olds. The agency said it used "a more justifiable and conventional statistical model" to analyze those results.

The new analysis showed a small and statistically significant effect of the additives on some children's attention and activity. However, the effects were not seen in all ages and were inconsistent for the two mixtures. The panel said there were not enough data on dose-response, nor was there a biologically plausible mechanism for additives to cause hyperactivity.

The agency said the clinical significance "remains unclear," and the findings cannot be used for changing acceptable daily intakes of the additives.

European Food Safety Authority summary (Free PDF)

Milk & Calcium intake in Children

Children's Dairy Intake in the United States: Too Little, Too Fat?

Kranz S, Lin P, Wagstaff DA J Pediatr. 2007;151:642-646; Epub 2007 Jul 24

Kranz and colleagues note that the most bioavailable food form of calcium occurs in dairy products, thus most professional organizations and advisory boards recommend that children obtain their daily calcium goals through dairy intake. However, whole milk contains almost double the amount of calories per unit volume (3.5% milk fat) compared with nonfat milk (less than 0.5% milk fat) without any additional calcium.

This study sought to compare daily calcium intake by US children. The authors used data from the 1999-2002 National Health and Nutrition Examination Survey (NHANES) and compared them against recommendations of the US Department of Agriculture's MyPyramid plan. The authors note that the American Academy of Pediatrics' (AAP) recommendations for dietary calcium exceed those of MyPyramid.

NHANES data were provided by subjects in an interview. The dietary data used in this study involved 24-hour dietary recall. The study included over 7000 children with dietary intake data, along with physical examination parameters. The current USDA dietary goals are 2 cups of dairy per day for children 2-8 years and 3 cups per day for children older than 8.

Only the youngest age group, 2- to 3-year-olds, met the 2-cups-per-day recommendation on the basis of their average intake. Children 4-8 years fell just short of 2 cups per day, while children 9-18 took in under 2 cups per day, far short of the goal of 3 cups per day for children older than 8.

In general, younger children obtained the majority of their dairy intake (approximately two thirds) from milk, but milk intake accounted for only half of dairy intake in the oldest children. When looking at the fat content of milk consumed, it was evident that whole milk and reduced-fat milk (2% milk fat) comprised a large majority of intake: 87% for children 2-3 years and 78% for children 4-8 years.

Even older children took in high proportions, with whole or reduced-fat milk comprising approximately 75% of milk intake for children older than 8 years, although there was a relative decrease in whole-milk consumption relative to reduced-fat milk.

The authors concluded that dietary intake of calcium is insufficient for children 4-18 years in the United States, and that the dairy products consumed are often unnecessarily high in fat.


It has taken barely a generation for milk to go from a "luxury" item in childhood diets to a potential "villain." Although the AAP recommends whole milk for children under 2 years old, we could clearly advocate that our patients should consume lower-fat varieties at older ages.[1] The authors also highlight that there has been a decline in dairy intake during adolescence, when dietary calcium needs increase significantly compared with young childhood. In this study, adolescents in the 14- to 18-year range took approximately 38% of recommended calcium.

Among the many topics to discuss at adolescent visits, diet and calcium intake specifically should remain an important one.

Pediatric Deaths From Influenza/MRSA Coinfection Spark CDC Advisory

Yael Waknine (Medscape Medical News)

January 31, 2008 — Healthcare professionals should be alert to the possibility of bacterial coinfection among children hospitalized with influenza and request bacterial cultures for those who are severely ill or suspected of having community-acquired pneumonia, according to a clinician communication sent today from the Centers for Disease Control and Prevention (CDC).

The warning was based on data collected via the Influenza-Associated Pediatric Mortality Surveillance system, showing that 44% of pediatric influenza-related deaths reported from October 1, 2006, through September 30, 2007, occurred in the setting of bacterial coinfection, and the majority of them (22 [73%] of 30) were caused by Staphylococcus aureus.

Although the number of pediatric influenza-associated deaths only increased moderately from the number reported during the 2 previous surveillance years, the number of deaths in which pneumonia or bacteremia resulting from infection by S aureus increased 5-fold, and many cases (15 of 22) were caused by strains of methicillin-resistant S aureus (MRSA) similar to those associated with US outbreaks of MRSA skin infection.

The median age of children with S aureus infection was higher compared with those having other infections (10 vs 5 years; P < .01), and coinfected children were more likely to have pneumonia and acute respiratory distress syndrome.

Healthcare providers are advised to be aware of the prevalence of MRSA in their communities when choosing empiric therapy for patients with suspected influenza-related pneumonia.

The CDC is requesting that all pediatric influenza-associated deaths be reported as soon as possible to local or state health departments, as well as to the CDC via its Web site, Information concerning bacterial pathogens should be included on the case-report form, and S aureus isolates should be sent to the CDC for further characterization.

Additional information regarding the CDC advisory may be obtained by contacting the Influenza Division, Epidemiology and Prevention Branch, by telephone at 404-639-3747.

Thursday, March 20, 2008

Rapid injection less painful

This is the Medscape Medical Minute. I'm Dr. George Lundberg.

We all know that it hurts to get vaccinated with needle injections. Babies cry. Pediatric researchers in Toronto performed a randomized controlled trial to test whether the usual standard of slow needle insertion, aspiration, slow injection, and slow needle withdrawal or rapid needle insertion, injection, and withdrawal without aspiration hurt more. The substance injected was the usual DPTaP-Hib immunization. They measured whether or not crying occurred, and its duration in 113 healthy 4- to 6-month-old infants. The slow technique resulted in 82% of the infants crying vs 43% in the rapid-technique group; the median duration of crying was 14.7 seconds vs 0. Both parent and pediatrician visual analog scales corresponded to these dramatic differences. There were no adverse effects.

The authors conclude that rapid is better than slow for routine intramuscular injections.

This Medscape Medical Minute article[1] is selected from Medscape Best Evidence.