Children’s health

Posted on Children's health

Children’s health will be negatively impacted by poorer fitness as global temperatures rise, new research shows

Happy children playing head over heels on green grass in spring park

Record levels of obesity and physical inactivity among children mean they are set to bear the brunt of poorer health effects from rising global temperatures – that’s the stark warning in a new comprehensive review of current studies on the topic.



Publishing her findings in the peer-reviewed journal Temperature, Dr Shawnda Morrison, an environmental exercise physiologist, argues that while physical fitness is key to tolerating higher temperatures, children are more obese and less fit than ever before.


Publishing her findings in the peer-reviewed journal Temperature, Dr Shawnda Morrison, an environmental exercise physiologist, argues that while physical fitness is key to tolerating higher temperatures, children are more obese and less fit than ever before.

This could put them at greater risk of suffering heat-related health problems, such as dehydration, heat cramps, heat exhaustion or heat stroke.

She says that current climate change policies fail to adequately address child health needs and that encouraging children to make exercise part of their everyday lives must be prioritised if they are to cope with living in a hotter world.

From Slovenia’s University of Ljubljana, Faculty of Sport, Dr Morrison is an expert in adaptive and integrative human physiology in extreme environments. She has over 20 years’ experience investigating sport performance and exercise physiology, especially in hot environments.

Her assessments are based on a comprehensive review of more than 150  medical and scientific studies into how children maintain physical activity, exercise, cope with heat, and how this might change as global temperatures rise.

The research she highlights includes a study of 457 primary school 5-12 year old boys in Thailand, which found that overweight youngsters were more than twice as likely to have difficulty regulating their body temperature as those of normal weight when exercising outdoors.

In another study, data from emergency departments at children’s hospitals in the US, found attendance was higher during hotter days.  Younger children were particularly likely to need emergency care.

The research has also found:

  • Children’s aerobic fitness is 30% lower than that of their parents at the same age.
  • There are rapid declines in child physically activity globally, especially over the last 30 years
  • Most children are not meeting the World Health Organization’s guideline of performing an average of at least 60 minutes of physical activity each day.
  • Physical inactivity was accelerated, especially in Europe, during the Covid-19 pandemic when schools and other societal infrastructures were closed.

Rising temperatures could restrict physical activity further when parents of children perceive outdoor temperatures to be ‘too hot to play’,  making it more uncomfortable for untrained or unfit children to meet the minimum physical activity levels to stay healthy, says Dr Morrison, who is also the Founder of Active Healthy Kids Slovenia.

Higher temperatures and changes in weather patterns are projected to also lead to outbreaks of new diseases entering the human population. If there are more movement restrictions put in place to contain novel diseases, this will have potentially devastating consequences to children’s physical fitness, mental and physical health.

Dr Morrison also points out that, in terms of thermoregulation – how the body maintains its internal, or core, temperature – young children are not simply smaller adults.  When exposed to the heat, children sweat less than adults; they lose heat by increasing blood flow to their skin – a process which can require the heart to work relatively harder.

Despite these differences, most of the research into how the body adapts to higher temperatures has been carried out on adults. The little mechanistic research done in children has mostly been conducted 15-30 years ago, when children’s fitness levels were much higher than they are today.

Dr Morrison concludes: “Fitter adults are better able to tolerate higher temperatures, due to a combination of physiological, behavioural and psychological factors.

“Yet, as the world warms, children are the least fit they have ever been. It is imperative that children are encouraged to do daily physical activity to build up, and maintain, their fitness, so that they enjoy moving their bodies and it doesn’t feel like ‘work’ or ‘a chore’ to them.”

Activities can be a combination of structured games, such as football, basketball and baseball, and active play with friends and family, preferably taking place outdoors. 

Physical education (PE) lessons taught by PE teachers are the best and most cost-effective way to increase fitness levels and equip children to continue exercising throughout their lives.  Families have a role to play, too, especially if schools offer little PE.

Dr Morrison says: “Do what you love to do, whether it’s a family bike ride or rollerblade, a stroll through the woods or walking the dog.

“Make sure the activity raises everyone’s heart rate, enthusiasm, and positive energy and importantly, try not to completely avoid the heat but choose times of the day that are less hot (mornings/evenings) to keep active, since we need to keep ourselves moving in this new warming world.”

As part of Dr Morrison’s ongoing work, she is looking to determine how physically active children and adults are during heatwaves, and how hot, uncomfortable, or thirsty they feel when performing these activities.

Posted on Autism, Children's health

Are neurodevelopmental disorders common in extremely preterm babies?

Baby and Mother
Baby and Mother

In an analysis of data from national Swedish registries for extremely preterm babies (born before 24 weeks) from 2007–2018, most had neurodevelopmental disorders and/or other diagnoses during childhood and were referred for habilitational care.

In the Acta Paediatrica study of 383 children, 75% had neurodevelopmental disorders (including speech disorders, intellectual disabilities, attention deficit hyperactivity disorder, autism s, visual impairment, cerebral palsy, epilepsy, and hearing impairment).

More boys than girls had intellectual disabilities (45% versus 27%) and visual impairment (25% versus 14%). Fifty-five percent of children were referred for habilitation services, and 88% had additional diagnoses such as asthma and short stature.

“Due to improved medical care, an increasing number of extremely preterm infants survive. Our study shows that a large proportion of the most immature new survivors suffer from persisting somatic and neurodevelopmental disorders,” said senior author Ann Hellström, MD, PhD, of Gothenburg University.

Such an understanding the long-term consequences of preterm birth will help clinicians and healthcare systems optimize care. “Awareness of the lifelong needs of these children is also necessary for society at large to provide adequate resources and support for the tiniest of our children and their families,” said lead author Eva Morsing, MD, PhD of Lund University.

Posted on Children's health, Obesity

Appetite genes control how children grow

HSE researchers compared expressive and receptive language abilities of Russian-speaking children with autism for the first time


Have you ever wondered why it is so different how quickly and how much small babies put on weight during the first years of life? Now researchers at the University of Bergen in Norway have found that this is largely controlled by our genes. The findings provide insight into the mechanisms that control appetite and energy metabolism early in life and can help us find better treatment for obesity in adolescence and adulthood.

After birth, we grow fast. The length increases by about 50% and the weight doubles during infancy. Then the growth slows down and goes into a stable phase in childhood until a growth spurt in puberty. But what drives this dynamic growth?

Researchers at the Center for Diabetes Research, University of Bergen, Norway have now found the explanation. They studied the genes of 30,000 children and their parents from the Norwegian Mother, Father and Child Cohort of Norway. Many millions of genetic variants from each individual was examined and linked to growth data from a series of measurements of height and weight from birth to eight years of age.

The findings have attracted a great deal of attention.

“It turned out that genes linked to extreme obesity, appetite and the body’s energy consumption are responsible for the growth regulation”, professor Pål R. Njølstad says.

“This is dynamic in that specific genes have an effect only on some of the different phases of growth. We believe that this is probably one of the reasons why parents have always noted that some children are born with a naturally higher appetite than others and have significantly more fat mass in infancy. It seems that these dynamic effects are especially important in the first years of life, and that they do not increase the risk of later obesity”, Njølstad says.

Some of the genes are linked to drugs that are being tested to slow weight gain in extreme obesity. The findings may thus be important for the treatment of normal obesity. The results are now published in the journal Nature Metabolism.

Posted on Children's health, Diabetes

Spike in severe pediatric type 2 diabetes complication during COVID-19 pandemic

Prediabetes


According to the Centers for Disease Control and Prevention (CDC), children generally appear to be less severely impacted by COVID-19 than adults. But a new study from Children’s Hospital Los Angeles shows that the pandemic could be affecting children’s health in unexpected ways. The study reveals a surge of patients presenting with diabetic ketoacidosis, a severe complication of type 2 diabetes. Published today in Diabetes Care, these data offer additional insights into how the pandemic may be impacting the nation’s children.

Diabetic ketoacidosis, or DKA, is life-threatening. “DKA happens when insulin levels in the blood drop too low for too long,” says Lily Chao, MD, MS, Interim Medical Diabetes Director at CHLA. “Insulin helps the body utilize glucose. So when there’s not enough insulin, the body starts breaking down fat as a source of energy.”

This process, she says, causes dangerously high levels of acids in the blood. If untreated, this can lead to cerebral edema, coma, or even death. “Kids are coming in with dehydration and DKA. But DKA is preventable and reversible if we treat it early and appropriately,” says Dr. Chao, who is lead author on the paper.

Dr. Chao and her colleagues noticed back in March of 2020 that more and more patients were coming in with DKA and type 2 diabetes. “We used to see a few DKA cases in type 2 diabetes a year,” she says, “and all of a sudden we were seeing a spike, so we began keeping track. Now we have the numbers to confirm that there are more children with type 2 diabetes who present with this very serious complication of DKA.”

Yet the question remains: What is the cause of the increased incidence of Type 2 diabetes with DKA?

A year into the COVID-19 pandemic, many children are used to wearing masks and attending online classes. But other changes have affected them, too. Fewer children may be making it to the doctor’s office for their routine well-child exams, possibly due to the fear families may feel about exposure to SARS-CoV-2, the virus that causes COVID-19.

“Parents are worried about going outside of the house,” says Dr. Chao. “Some families have to take public transportation to go the pediatrician and they are hesitant to do so during the pandemic.”

This, she says, may be one of the reasons for the shift she and her colleagues have seen.

In addition to missing doctor visits, other factors may be involved, such as less physical activity during lockdown or reduced access to fresh, healthy foods. But there may also be a biological relationship between exposure to the virus and diabetes.

“There is definitely a link between COVID-19 and diabetes,” says Senta Georgia, PhD, an investigator in The Saban Research Institute of Children’s Hospital Los Angeles and senior author on the paper. Dr. Georgia runs a basic and translational research program aimed at understanding the cellular biology of diabetes and developing novel therapeutics. “We don’t know whether SARS-CoV-2 infects insulin-secreting cells in the pancreas,” she says. “There are some reports of a link between COVID-19 and diabetes in adults, but no pediatric studies have been published to date.”

As a physician scientist and a laboratory scientist, respectively, Dr. Chao and Dr. Georgia come with unique perspectives–but their objectives converge on getting answers to help children diagnosed with diabetes.

“Our work together at Children’s Hospital Los Angeles allows us to address pediatric health on multiple levels,” says Dr. Georgia. “I help Dr. Chao design her clinical studies and she works with me on our basic and translational research. So we’re coming at the problem of increased incidence of diabetes with both a clinical and a scientific perspective.”

Future translational and clinical studies may determine whether increased DKA in patients could be caused by infection with SARS-CoV-2. But for now, the data clearly point to an emerging trend toward more severe diabetes complications during the global pandemic.

The team hopes that these findings will increase vigilance. “It’s critical for pediatricians to recognize that when a child presents with symptoms of diabetes, the child needs to be evaluated right away,” says Dr. Chao. “The sooner we see these kids, the better chance we have to prevent DKA.”

Posted on Children's health, Lupus

Helping childhood-onset lupus patients stay healthy as adults


Southwestern researchers have identified factors that put patients with childhood-onset lupus at elevated risk for poor outcomes, such as end-stage renal disease or death, as they transition from pediatric to adult health care. The findings, published online in Seminars in Arthritis and Rheumatism, emphasize the precarious nature of this period and shine a spotlight on areas prime for intervention to help protect these vulnerable patients. CREDIT UT Southwestern Medical Center

UT Southwestern researchers have identified factors that put patients with childhood-onset lupus at elevated risk for poor outcomes, such as end-stage renal disease or death, as they transition from pediatric to adult health care. The findings, published online in Seminars in Arthritis and Rheumatism, emphasize the precarious nature of this period and shine a spotlight on areas prime for intervention to help protect these vulnerable patients.

Patients with chronic diseases that used to be fatal early in life now often survive to live long lives. However, says study senior author Bonnie Bermas, M.D., professor of internal medicine at UTSW, while pediatric patients often have significant support in managing their conditions as children, they are expected to take much more responsibility for their health care as they transition to adult care.

Studies have shown that patients with chronic diseases such as HIV and sickle cell disease tend to have poor outcomes during this time. As an adult rheumatologist who cares for young adult patients with childhood-onset lupus erythematosus, an autoimmune disease, Bermas says she has witnessed a similar phenomenon. However, it’s unclear what factors put young lupus patients who transition to adult care at higher risk.

To explore this question, Nicole Bitencourt – a former UTSW pediatric and adult rheumatology fellow who is now on the faculty of the University of California Los Angeles Medical Center – along with Bermas and her UTSW colleagues used medical records to identify childhood-onset lupus patients who transitioned to adult care between 2010 and 2019. These 190 patients were seen at two different rheumatology clinics: One is a safety-net hospital that mainly treats patients with public insurance; the other is a university hospital that primarily sees patients with private insurance.

The researchers followed patients for an average of nearly 3.5 years and looked at three major outcomes: time to the first hospitalization following a patient’s final pediatric rheumatology visit; time to end-stage renal disease, a condition in which severe kidney failure necessitates dialysis; and death.

Of the 190 patients, 11 percent developed end-stage renal disease and 5 percent died during the follow-up period. Out of 114 patients with hospitalization data, 53 percent were hospitalized as young adults.

The research team found several factors linked with these poor outcomes. End-stage renal disease and death were associated with having public health insurance, a history of Child Protective Services involvement, and an unscheduled hospitalization during the final year of pediatric care. A shorter time to hospitalization in adult care was linked with a pediatric outpatient opioid prescription and Black race or Hispanic ethnicity.

Bermas, the Dr. Morris Ziff Distinguished Professor in Rheumatology, notes that these findings could help health care providers better target childhood-onset lupus patients who might be at higher risk of poor outcomes during their transition to make sure they have the support and resources needed to stay healthy after they become adults.

“Transitioning to young adulthood has its own challenges, but these patients are struggling with a chronic disease on top of that. We’re asking an awful lot of these patients to navigate the medical system, often with little support,” says Bermas. “By identifying those patients who may need more help, we can improve outcomes and even potentially save lives.”