Posts Tagged ‘TV’

Reading to your children has demonstrable positive effects on their brain development

August 13, 2015  |  General  |  No Comments

The beneficial effects of stimulating a child’s brain have been known for decades, at least in general terms. That is to say, children who have been regularly played with, read to, and generally interacted with by adults have a great advantage over those children who did not receive these things. The key period for this appears to be up to the age of three years. For an example of this sort of research see here, whose authors conclude:

Child development was strongly associated with socio-economic position, maternal schooling and stimulation.

General observations like this demonstrate how mental growth is entangled with the effects of socioeconomic status. Children who are economically disadvantaged encounter many problems that affect cognitive development, such as poorer nutrition, more chaotic home life, and emotional stress. Any solid information on the effect of stimulation, and of what kind, would help us sort out the relative importance of these various things. Now we some fascinating recent data about that issue.

A recent study used functional magnetic resonance imaging (fMRI) to examine just what reading to a child does to the child’s brain. The reason to examine reading in particular is that literacy and language skills correlate  with later achievement. As the investigators state:

Disparities in home cognitive environment during childhood can have dramatic impact on achievement and health. Parent-child reading has been shown to improve certain emergent literacy skills, though its effect on the brain has not yet been shown.

So a big question here is precisely what does mental stimulation, particularly reading, do to a child’s brain? Can we document what is happening between the ears? Now we have some information about that. The investigators did fMRI scans on children to identify what regions of the brain reading activated. What they found was this (from the American Academy of Pediatrics summary):

Results showed that greater home reading exposure was strongly associated with activation of specific brain areas supporting semantic processing (the extraction of meaning from language). These areas are critical for oral language and later for reading. Brain areas supporting mental imagery showed particularly strong activation, suggesting that visualization plays a key role in narrative comprehension and reading readiness, allowing children to “see” the story. This becomes increasingly important as children advance from books with pictures to books without them, where they must imagine what is going on in the text.

It is important that these observations held up even after controlling for socioeconomic status. I should note that this research is reported in what we term abstract form — the complete details are yet to be published. It also has not been confirmed (as far as I know) by other investigators yet. Even with these caveats, finding a physical locus in the brain for complicated mental events is exciting stuff.

There is a footnote to this research that goes back to the Baby Einstein controversy in 2007. If you didn’t know, the Baby Einstein products were videos whose authors claimed were educational in the sense of improving learning and brain development in infants and toddlers. The company was sued for false advertising claims and the Disney Corporation (the owner) paid out refunds to those who had bought them. More about that controversy here. Research published in 2007 actually showed regression of language in children who watched a lot of these videos. So how can we square that with the experience of reading to your child being good for the brain?

I have no data to offer about this, but I suspect the difference between putting your child in front of a TV and reading to him or her is the personal interaction that accompanies reading.


SLAPPS in Medicine: Can medical researchers ever be at risk for being sued for libel?

March 5, 2015  |  General  |  No Comments

It has become a common technique for large companies or other powerful organizations, when they meet public opposition, to use a strategy called strategic lawsuits against public participation, or SLAPP for short. I have seen one of these in action. In the case I observed, a large development company wanted to obtain a parcel of public land by offering the US Forest Service a swap for an obviously inferior piece of land the company owned. Many citizens objected and organized against the proposal. Their actions had a reasonable chance of blocking the land swap. The company responded by suing the leaders of the citizens’ group — a SLAPP. The key concept of these suits is not that the instigators expect to win them They almost never do, even on the rare occasions when they make it to trial. But just the threat of a lawsuit and huge monetary damages has a chilling effect on ordinary people, who do not have armies of lawyers. It puts them through stress and, most importantly, great financial cost to contest the SLAPP. It has the effect of frightening off opposition.

Could a similar process happen in medical research? A recent example suggests that this is possible. The details are presented here. The authors ask this question:

Does fear of libel lawsuits influence what gets published in medical journals? We suggest it may, especially when the conclusions run counter to corporate interests.

The particular case involved a study in which the researchers investigated the relationship between TV advertisements for fast food and children’s perception of the product. As it happens, 99% of fast food advertising directed at children comes from only two companies: MacDonald’s and Burger King. The investigators concluded that the companies failed to comply with the guidelines of the Children’s Advertising Review Unit of the Better Business Bureau. The authors then submitted their findings to Pediatrics, a journal of the American Academy of Pediatrics. The manuscript review process stopped when the legal department of the Academy recommended that the names of the fast food companies be removed from the paper. The lawyers were concerned about being sued by one or both of these fast food giants. However, the authors believed that naming names was important and they withdrew the paper from consideration. Here is what they were told by the journal editor:

In the event that a defamation claim is brought as a result of the publication of this article, the publishing company could be named as defendants. Based on these findings and advice from counsel, we recommend the article not be published.

The article eventually was published by the journal PLOS One, with the company names included. This series of events raises important questions for medical research. Remember the point of SLAPPs is not to actually win a libel suit. Rather, it is to put the SLAPP target though trouble and expense sufficient to warn them off. Valid medical research cannot be libel. There is actually a 1994 court decision (Underwager v Salter) that states scientific disagreements should be decided in the scientific, not the legal arena. And truth is always a defense against libel.

I have no idea if this sort of thing is an isolated instance or happens more frequently. I have long been concerned that, with the decline of federal NIH support for medical research, industrial financial support carries the risk of compromising the work. This is what cannot be allowed to happen:

. . . any article that reaches negative conclusions about a company’s practices or products risks rejection, as it is company practice today to strategically threaten libel suits to ward off legitimate criticism.

This is serious issue, one all of us who use the medical research literature need to think about.

Most new parents don’t know how to use a car seat correctly, vitamin D, and more: Pediatric Newsletter #11

October 27, 2014  |  General  |  No Comments

Here is the latest of my more or less monthly newsletter on pediatric topics. In it I highlight and comment on new research, news stories, or anything else about children’s health that I think will interest parents. If you want to subscribe to it and get it in the form of an email each month there is a sign-up form at the very bottom of my home page.

About those physician rating sites: do parents use them to find a physician for their child?

There are now a multitude of web sites on the internet that allow consumers, that is patients and their families, to rate physicians. And why not? There are rating sites for many other products and services. But these sites can strike fear into the hearts of doctors because, when you look at them, the number of ratings for a particular physician is usually quite low. In my own case, for example, a popular rating site only lists one for me even though I’ve been practicing for 30 years. So there is the fear that one disgruntled patient can tank your rating. But these sites are here to stay, I think. A big question is if parents use them to find a doctor for their child: or, if they haven’t used them, would they? A recent survey asked that question and found that parents are beginning to use the information on the sites. My concern is that, if this is the future, they be run a little better. For example, Angie’s List, a popular one, has contacted me several times to ask me to rate myself. I assume it was a computer glitch, but the potential to cook the books is always a concern with anonymous rating sites.

Long term treatment of ADHD with stimulant medications does not affect growth

Pediatricians are always concerned that long term treatment with any medication could affect a child’s growth. This is true for any medication, but it is a particular concern for attention deficit/hyperactivity disorder (ADHD) because there are so many children taking these medications and they often take them for many years. A recent study in the journal Pediatrics is reassuring on that point. The authors studied a large group of children through childhood and on into adulthood and found no effect on growth.

A related, and important point, is how common is ADHD? A recent report from the Centers for Disease Control (the CDC) used surveys of parents to assess that issue. What they found is that 11% of all children between the ages of 4 and 17 had at one time or another been given the diagnosis of ADHD, and 83% of those still carried that label. And 69% of the total were currently taking ADHD medication. That represents a whopping 43% increase over the past decade. For myself, I find it hard to believe ADHD is increasing at that rate; it’s more likely increased awareness of the condition, but there also may be a component of you find what you look for.

What is my advice to parents about this? I’m not an ADHD expert, I’m a critical care pediatrician, but it seems to me to be a stretch to categorize 11% of all children as abnormal — that even defies the definition of what the word normal means. If your child’s teacher wants you to get ADHD medications for your child, I would first carefully look into the details of the concerning behavior. How troublesome is it really? Could there be other explanations? Could more structure help? Then see a physician or psychologist with experience with ADHD. If the recommendation is for medication, for myself I’d seek another opinion and see if they agree. This is an area in which parents should be the ones driving the bus.

Most parents don’t know how to use a car seat when they leave the hospital with their newborn infants

There is no question that car seats save lives. Since their use has been mandated by law, the death and injury rates of children involved in motor vehicle accidents have fallen dramatically (40-50%). But the seats need to be used correctly. A recent report suggests that new parents need more help in figuring out how to install and use them. In fact, 93% of new parents made at least 1 critical error in using the seat. So if you’re not entirely sure if you’re doing it right, have someone check. Our hospital, like all hospitals delivering babies, has specially trained nurses that can look at your seat, your car, and make sure the seat is installed right. There are also quite a few good online sites (like this one) telling you about different kinds of seats, which children need which ones, and how to install them.

Lower vitamin D levels found in children who drink non-cow’s milk

Many children do not drink cow’s milk. This may be because of a sensitivity to cow’s milk protein, a common condition, or because of parental preference. Parents of children in this situation should know that this brings a risk of reduced vitamin D levels in the blood. Commercial cow’s milk is fortified with vitamin D, as are infant formulas that don’t contain cow’s milk. A recent studymeasured vitamin D levels in children who don’t drink commercial cow’s milk and found that many of these children had low vitamin D levels.

Vitamin D has long been known to be crucial for bone growth. Rickets, a once common bone disease in children caused by low vitamin D, is now extremely rare since milk has been fortified with the vitamin. We also know now that vitamin D has many other functions, such as in cardiovascular health. Our body can make vitamin D if exposed to sufficient sunshine, but this is not a reliable source. Of note, the above study comes from Toronto, and rickets was once much more common in climates where children get less sunshine exposure.

The bottom line is that if your child does not drink fortified cow’s milk he or she is at risk for low vitamin D. Your child’s doctor can help you with identifying the best way to supplement this key nutrient.

A smartphone app for jaundice, effects of digital media on children’s brains and more: Pediatric Newsletter #10

September 30, 2014  |  General  |  No Comments

Here is the latest of my more or less monthly newsletter on pediatric topics. In it I highlight and comment on new research, news stories, or anything else about children’s health that I think will interest parents. If you want to subscribe to it and get it in the form of an email each month there is a sign-up form at the very bottom of my home page.

Coming soon: A smartphone app to see if your baby is too jaundiced

This bit of news is pretty interesting, although the product is still in development. These days babies typically go home from the hospital when they’re a day old or even less.Newborn jaundice is very common, especially in breast-fed babies. Nearly all the time it means nothing and passes without treatment. Once in a while, though, the blood bilirubin, which causes the jaundice, gets dangerously high. We treat it with phototherapy. It takes a blood test to measure the blood level, although we’ve used devices for years in the hospital that estimate it from the skin color, identifying those babies that need the blood test. Now it looks as if there will be a way to screen your baby at home using your cell phone and then sending the results to you doctor. I think it’s a cool concept.

Let them sleep in more: American Academy of Pediatrics recommends delaying school start for adolescents

Every parent with a teenager knows they like to sleep more. To no one’s surprise, this is because they need more sleep to be healthy and sharp for school. Research has shown real benefits for mental and physical health. Starting school at 7:30 in the morning, or even earlier, is particularly hard for adolescents. Recognizing this, the AAP has come out with new recommendations for middle and high school start times, suggesting 8:30 am as more appropriate.

Who knows if this will go anywhere because the logistics of getting kids to school and parents to work on time can make it tough to change things. After school activities, such as sports, would also be affected if practice times are pushed back. But it seems pretty clear that a later start would be better for teenagers.

Children who use digital media a lot may be less able to read actual human emotions

This one is interesting. All of us, especially children, are spending a lot more time staring at digital screens — computers, smart phones, video games. A research report coming out next month suggests this may not be a good thing for emotional development. Children, who have not yet fully developed human interaction skills, may be less able to read emotions on actual human faces if they spend a large amount of time with screens.

The researchers found that children whose access to electronic devices was limited were better able to read other people’s emotions. The authors concluded: “Decreased sensitivity to emotional cues – losing the ability to understand the emotions of other people – is one of the costs. The displacement of in-person social interaction by screen interaction seems to be reducing social skills.

“I’m not surprised by this, really, and I find it concerning. It’s one of several reasons my wife and I monitor and limit our son’s computer and smart phone time.

High levels of physical activity linked to early academic achievement

Every parent knows that physical activity is good for children. Among other things, being active and not parking in front of the TV is linked to a lower level of obesity. A new study from Finland suggests that a higher than average level of physical activity is also linked to improved academic performance in elementary students, particularly among boys.

The authors observed 186 children during recess for the first 3 years of schooling and also collected other information on physical activity, such as riding a bike to school: “The improvements in academic attainment were most striking in male participants, especially with reading skills. Boys with higher levers of physical activity, and in particular walking or cycling to school, had better reading skills than the less active boys.

“I was interested to see this research but it seems to me to be confirming common sense. What it is really saying is that if you encourage children, especially boys, to run around a lot and work out their energy, they concentrate better in the classroom. It reminds us that old-fashioned recess is getting rarer and rarer. A half-hour of unstructured play time used to be common; it no longer is.

Are we making progress in childhood obesity?

Are we making progress in childhood obesity?

November 28, 2013  |  General  |  No Comments

It is well known that more people today are overweight or obese than in the past. This has been a steady trend for decades, but there is some recent evidence this increase has stabilized. This is promising. Since many obese adults began as obese children, during the last decade physicians who care for children have devoted considerable effort to reversing the trend. This is important because obesity sets up the individual for a host of chronic disease problems later in life. How well are we doing? Are we getting anywhere? A recent study published in the journal Pediatrics gives us some answers about that question.

The study was a survey of adolescents during three time periods: 2001-2002, 2005-2006, and 2009-2010. The survey looked at several things. These included physical activity and screen time — time spent watching TV, playing video games, etc. It assessed several dietary issues, including number of portions per day of fruits and vegetables, sweetened beverage consumption, and chocolate and other sweet intake. The survey also measured how many days each week a child ate breakfast, since skipping breakfast has been associated with weight gain.

What did the investigators find? Well, there is both encouraging and discouraging news. First, the encouraging news: they found improvement in all the measures. On average, over the time period studied, kids exercised a bit more, ate more fruits and vegetables and drank less sugary drinks, and spent a bit less time in front of the TV. These encouraging trends happened across all age and socio-economic groups.

The discouraging news is that, first, although the average of these behaviors was in the right direction, the majority of adolescents still rank poorly in all these measures that are associated with obesity. More than that, obesity, as measured by the body mass index (BMI), continued to increase over the time period, rising from 10.3% of adolescents in 2001 to 12.7% in 2009. Yet there is a glimmer of hope: the increase occurred between 2001 and 2005. There was no change between 2005 and 2009. In addition, the number of kids classified as overweight but not obese dropped just a bit. The graph from the article lays out what is really the bottom line.

This study also brings up an issue we see a lot in clinical medical research: the contrast between process measures and actual outcome measures. For example, we assume that emphasizing hand washing decreases infection rates in hospitals. So we focus on the process measure of improving hand washing rates. Unfortunately, process measures, especially of complicated, multi-factorial problems like obesity, don’t always reflect the underlying problem we are studying.

The other issue that sometimes comes up is that the process measure we think improves the situation is actually just an association, not a cause and effect thing. If that’s the case improving the process measure may not have any effect on the basic problem.

Still, I am encouraged by these results and hope they persist over time.

Want your kids to watch less TV? Watch less yourself

September 9, 2013  |  General  |  No Comments

Most educators, and plenty of parents, think children these days spend too much time in front of a screen — computer screen, video game screen, or television screen. It is the last of these that has particularly interested physicians who care for children because increased TV time is associated with some health problems. For example, there is a correlation between time spent watching TV and the propensity to develop asthma. It’s not that TV causes asthma, but that children who spend hours each day watching it are more likely not to have less healthy lifestyles overall — like the kid in the picture.

Several things are associated with children spending more time in front of the tube. Not surprisingly, having a TV in a child’s bedroom is one. The American Academy of Pediatrics is particularly concerned about TV use in children under two years of age — here is their policy statement about that.

A new study, whose author one could easily call Captain Obvious, demonstrates that the highest correlation regarding how much TV a child watches is with how much his or her parents watch. Still, it’s helpful to have research confirm common sense.

So, if you want your child to watch less TV, watch less yourself.

Interesting technology for monitoring doctor and nurse handwashing before patient contact

August 6, 2013  |  General  |  No Comments

We’ve known since Dr. Semmelweiss began washing his hands between patients that good hand hygiene slows down or prevents the spread of infection. From the days I was a nurse’s aide in the 1960s I was taught to wash my hands before and after I touch a patient. I suppose I miss a few times, but I do my best to remember always to do that. Broadly speaking, though, how well do doctors and nurses do with adhering to those rules? Not so well, I’m sorry to say — usually only 60-70% of the time. It’s a bit hard to measure because direct observation to count the times in itself can serve as a reminder, goosing up the number. Then, when the observation stops, the rate often drops down to where it was before. This is a variant of the so-called Hawthorne effect: the behavior is altered (generally improved) just by the study itself.

Since hand hygiene is so simple to do and has such beneficial effects many facilities and organizations, including the World Health Organization and the Centers for Disease Control, have tried to push the compliance rate higher. An important component of this effort is to figure out ways to measure it without falling into the fallacies I noted above. How to do that?

Some studies have used closed circuit television to observe doctors and nurses. Others have used observers, but without letting the subjects know they are being watched. That seems a little bit sneaky, but it does produce more accurate numbers if you do it long enough so the caregivers forget it’s there. It is pretty labor-intensive, though, and therefore not well suited to ongoing quality control.

Recently I ran across a study of an interesting technology that monitors how often the hand sanitizer or soap dispenser in a patient’s room is activated. The notion was to validate that number against closed circuit TV observation to see if the simple number of activations of the dispenser corresponds to some expected number, on average, if everybody were doing good hand hygiene. The device works by sending an electronic signal to a remote server that keeps track. The researchers then developed an algorithm that linked activation of the dispenser signal with traffic in and out of the room as determined by video monitoring. The study compared washing inside the patient’s room with what is called the “in/out” method: caregivers are instructed to used a hand sanitizer dispenser beside the door to the patient’s room going in and coming out. They also had a phase of direct observation which, not surprisingly, increased compliance. The results were interesting:

This study validates the HOW2 Benchmark Study algorithm. It also documents a 36% deficit in hand hygiene opportunities using the In/Out method and a ~30% Hawthorne Effect due to direct observation. There is an extremely high correlation between actual video-taped hand hygiene compliance and the electronic monitoring system’s hand hygiene compliance index.

This all may seem a bit Big Brother-ish to people, but really, lives are at stake — hospital-acquired infections are a huge problem, and simple things like hand washing reduce them substantially. This is one way to get objective data to see if your educational efforts for the caregiver staff are getting anywhere. Although my hospital stresses the in/out protocol and has dispensers outside every patient room, I prefer to wash my hands in the sink at the patient’s bedside. For one thing, it’s been my routine for 45 years. For another, I think it is reassuring to families to see me wash my hands in front of them and their child.


Exposure of children to background television: how much and with what effects?

April 8, 2013  |  General  |  No Comments

There is a fair body of research looking at the amount of television children watch. On a typical day, a child in America between the ages of infancy and 6 years watches about an hour and a half of TV. The effects of this on the child appear to be content-based. In particular, violence and other content inappropriate for children are associated with negative outcomes. In contrast, “pro-social” and certain varieties of educational content are associated with positive outcomes.

Very little, however, is known about the effects of background TV, those times when the television is on and in the room but nobody is really watching it. There is some research suggesting that increased background TV is associated with lower sustained attention during playtime, which is concerning, but which has not been verified with further research. A key question is just how much background TV children are exposed to. If kids spend an hour and a half watching TV each day, how many hours are they exposed to of background TV? A recent study in the journal Pediatrics gives some data about this question. The article also has references at the end if you want to track down the medical literature about the effects on children of watching different kinds of TV. (The full article is behind a paywall — if anybody wants the full version let me know.)

The study was a survey of about 1,500 households using daily diaries. The mix of families was a pretty close match to a cross-section of the population in racial and socio-economic characteristics, such as income and educational level. The results showed that the average child is exposed to 232 minutes of background TV — nearly four hours. This is a pretty startling number. Not surprisingly, having a TV in the child’s bedroom really jumped the exposure number.  I think a TV in the bedroom of a young child is a really bad idea, just on general principles, but this is another reason not to have one.

The effects of this background TV exposure are still unclear, but I doubt they can be good.