In newborn mice, at least, mother’s milk appears to have some rather immediate and potentially far-reaching metabolic consequences. The milk intake kick-starts the liver to produce a molecule that then turns on heat-generating brown fat.

“A key phenomenon required after birth is to adapt the body to a lower environmental temperature with respect to that experienced when the fetus is inside the mother’s womb,” said Francesc Villarroya of the University of Barcelona. “We find that a key inducer of heat production in neonates is FGF21, released by the liver in response to the initiation of suckling.”

FGF21 (short for fibroblast growth factor 21) has recently emerged as a novel regulator of metabolism, Villarroya explained. Scientists knew that FGF21 is produced primarily in the liver, where it is induced after fasting in adult rodents and humans. FGF21 can also correct metabolic disorders of obese and diabetic mice.

In the new study, the researchers wanted to know whether FGF21 also has a role in metabolic shifts as newborn animals transition to life in the world. It appears that it does.

Plasma FGF21 levels and FGF21 gene expression in the liver rise dramatically after birth in mice, the researchers report. That increase is initiated by suckling and depends on the intake of lipid-rich milk. When the researchers mimicked the FGF21 postnatal rise by injecting FGF21 into fasting neonates, they found that the treatment enhanced the expression of genes involved in heat generation, or thermogenesis, within brown fat, to increase body temperature. Brown fat cells treated with FGF21 showed increased expression of thermogenesis genes. The cells also expended more energy and burned more glucose.

Villarroya’s team thinks what happens in those first hours of life may have consequences for the individual that carry over into adulthood, noting that FGF21 is a powerful antidiabetic agent.

“There are many evidences that alterations of dietary, genetic, environmental, or other origin in the metabolic performance during the fetal and early neonatal life can make an individual prone to develop diabetes and obesity in adulthood,” he said. “The precise mechanisms by which this happens are not fully understood. We observe that a ‘natural’ event in the postnatal life is a burst in FGF21 levels in response to suckling. It will be important to know whether any disturbance in the intensity of this naturally occurring event may have negative consequences in adulthood.”

Villarroya said that there has been something of a revolution in thinking about brown fat in recent years. That’s because scientists have found active brown fat in adult humans and have reported evidence that greater activity within brown fat can lend an individual greater resistance to obesity.

He says he suspects the pathways observed in neonatal mice do play similar roles in newborn humans, and maybe in adults, too. “It remains to be demonstrated if FGF21 is also an activator of brown fat in adult humans, but this would be of utmost importance for studies on complex metabolic diseases in adult humans,” he says.

Children and adolescents spend more time with media than they do in any other activity except for sleeping – an average of seven hours a day. The vast majority of young people have access to a bedroom television, computer, the Internet, a video-game console and a cell phone. In a review article, “Health Effects of Media on Children and Adolescents,” published in the April issue of Pediatrics (appearing online March 1), researchers review recent research on the effects of media on the health and well-being of children and adolescents. Research has found that media can influence children’s beliefs and behaviors in terms of violence and aggression, sex, substance abuse, obesity and eating disorders.

Heavy television viewing has been linked with attention-deficit disorder and diminished academic performance, as well as hypertension, asthma, sleep disorders, mood disorders, psychological distress and depression. Media can also be a positive influence and teach children empathy, tolerance toward people of other races and respect for their elders, as well as convey important public health messages. Study authors provide recommendations for parents, health care practitioners, schools, the entertainment industry and the government to increase the benefits and reduce the harm that media can have.

A systematic review that is published in the current issue of Psychotherapy and Psychosomatics by Schulte and associates (University of Bremen, Germany) analyzes what is the psychosomatic component of abdominal pain with no apparent cause in children.

The objective of this study was to review the extant literature on functional abdominal pain in childhood through the lens of the developmental psychopathology perspective and to systematize research results by means of a two-stage pathway model in which the emergence of functional abdominal pain and its potential transition into a somatoform adjustment disorder is outlined. The investigators used electronic searches for published studies and previous reviews about functional abdominal pain. An association of functional abdominal pain with internalizing symptoms, poor well-being of family members, major life events and daily stressors was found. The impact of stress on pain seems to be moderated by the children’s coping style and their perceived competence and self-efficacy to manage the pain experience. There is evidence for the influence of modeling and operant mechanisms on pain experiences. A new term, ‘somatoform adjustment disorder’, and its relation to functional abdominal pain is discussed. It seems that those children with functional abdominal pain who cannot adapt to the pain indeed run the risk of developing a somatoform adjustment disorder.

A study published Online First reports that cardiopulmonary resuscitation (CPR) by bystanders increases the likelihood of survival for children who have cardiac arrests outside of a hospital. In addition, CPR that includes chest compressions with rescue breathing is more important for non-cardiac causes of cardiac arrest, such as drowning, than chest compressions alone. The study is the work of Dr Taku Iwami, Kyoto University Health Service, Kyoto, Japan, and colleagues.

CPR has been shown to improve survival rates. The American Heart Association recommends CPR by bystanders with chest compression only for adults who have cardiac arrests outside of a hospital. But, such an association for children has not been confirmed because the majority of earlier studies have not had a sufficient sample size.

This population-based cohort study was nationwide. The researchers enrolled 5,170 children aged 17 years or younger who had had a cardiac arrest outside of a hospital. Data were obtained on whether or not the children had been given CPR, and if so, whether or not it was compression-only CPR or CPR with rescue breathing. The primary endpoint was a favorable neurological outcome at one month after the cardiac arrest. This was defined by a Glasgow-Pittsburgh cerebral performance category of:

• 1 :good performance
• 2 :moderate disability

Results indicate that a favorable neurological outcome was about three times more likely for children who had been given any CPR by a bystander than for those who had not. Conventional CPR with rescue breathing in children whose cardiac arrests had a non-cardiac cause was more likely to improve survival than compression-only CPR. Both types of CPR had similar effect for children whose arrests were cardiac in cause.

The authors remark: “Unlike previous studies that were underpowered to show this important association, our study is sufficiently large to identify the important beneficial effect of bystander CPR on survival outcomes after paediatric cardiac arrest.”

They write in conclusion: “Our data lead us to lend support to a double CPR training strategy: compression-only CPR training for most people to increase bystander CPR by bystanders, and conventional CPR (chest compression plus rescue breathing) training for individuals who are most likely to witness children who have cardiac arrests with non-cardiac causes, such as medical professionals, lifeguards, school teachers, families with children, and families with swimming pools.”

In an associated note, Dr Jesús López-Herce and Dr Angel Carrillo Alvarez, Pediatric Intensive Care Service, Hospital General Universitario Gregorio, Madrid, Spain, comment that this study “confirms that early bystander-initiated CPR is one of the fundamental factors to improve prognosis, in adults and children.”

They mention that Iwami et al’s information: “underline the importance of not extrapolating findings from adults to children, because cardiac arrest in children has specific characteristics. In adults, 65% of out-of-hospital cardiac arrests are of cardiac origin, whereas in children at least 71% are of non-cardiac origin. 71% is probably an underestimate because the diagnosis of cardiac origin was by exclusion in today’s study and, in other studies, cardiac causes accounted for less than 10% of cases.”

They say in closing: “Chest compression plus ventilation should continue to be the standard, a technique that should be taught to the whole population.”

“Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: a prospective, nationwide,population-based cohort study”

A survey of parents who had a child die of cancer found that one in eight considered hastening their child’s death, a deliberation influenced by the amount of pain the child experienced during the last month of life, report Dana-Farber Cancer Institute researchers in the March issue of Archives of Pediatrics & Adolescent Medicine.

The study, the first to explore this sensitive area, suggests that many parents worry that their children will suffer from uncontrollable pain, and that some parents might consider that an early death would be preferable. The researchers say the findings underscore the importance of managing patients’ pain, and of communicating with parents about the tools available for easing progressive pain.

“The problem is that conversations about these family worries may not always happen,” said senior author Joanne Wolfe, MD, MPH, Division Chief of Pediatric Palliative Care at Dana-Farber and Director of Palliative Care at Children’s Hospital Boston. “Parents may not have the opportunity to express these feelings and considerations, and as clinicians, we may not be adequately enabling sufficient opportunity for them to talk about their concerns.”

Wolfe, along with first author Veronica Dussel, MD, MPH, a Dana-Farber research fellow, undertook the research to gain an understanding of why some parents would consider a measure as extreme as intentionally ending a child’s life.

The researchers interviewed 141 parents of children who had died of cancer and were treated at Dana-Farber, Children’s Hospital, or Children’s Hospitals and Clinics of St. Paul and Minneapolis, Minn.

The scientists queried parents about their behaviors and feelings leading up to their child’s death and at the time the survey was conducted, which was a year or more after the death. The parents were also presented with hypothetical vignettes involving a terminally ill child with uncontrolled excruciating pain or who was in an irreversible coma.

One in eight (13 percent) of parents had considered asking caregivers about the possibility of ending their child’s life, though only 9 percent reported having such a discussion. Five parents, or 4 percent, had requested that their child’s death be hastened, and 3 parents said it had been carried out, using morphine. Wolfe commented, however, that “this may not reflect what actually happened, because morphine is used in increasing doses to manage worsening pain without the intent or the effect of ending life.”

In response to the hypothetical vignettes, 50 percent of parents said they endorsed hastening death in situations of uncontrollable pain or if the child was in an irreversible coma. Parents were 40 percent more likely to approve hastening death for a child experiencing extreme pain than for a terminally ill child in a coma.

Wolfe said it is important to keep the findings in perspective. Only five parents reported having talked about hastening their child’s death, and 19 said they considered it. Wolfe said it is her experience that parents are comforted by having conversations about pain management and that most are reassured by knowing what will be done to ease their child’s suffering.

“We’ve come a long way, because we have a good palliative and supportive care program for children with cancer,” said Wolfe, who is also an assistant professor of pediatrics at Harvard Medical School.

But she acknowledged, “I can never promise that their child will be pain free. We still have quite a way to go in figuring out the best way to ease suffering at the end of life.” The gap exists in part, Wolfe said, because this area is not one given high priority for research funding agencies.

According to a new study accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM), obese teenage girls with a greater ratio of visceral fat (fat around internal organs) to subcutaneous fat (fat found just beneath the skin) are likely to have lower bone density than peers with a lower ratio of visceral to subcutaneous fat.

“Visceral fat is known to increase the risk of diabetes and heart disease in obese people,” said Madhusmita Misra, MD, of Massachusetts General Hospital and senior author of the study. “Our study suggests that visceral fat may also have an impact on bone health. This finding is particularly relevant given the rising prevalence of obesity and recent studies suggesting a higher risk of fractures in some obese individuals.”

In this study, researchers examined 30 adolescent girls (15 obese/15 normal weight) between the ages of 12 and 18 years. After measuring weight and height, researchers used magnetic resonance imaging (MRI) to measure subcutaneous and visceral fat tissue and dual energy x-ray absorptiometry (DXA) to assess bone density at the spine, hip and whole body. They found that subcutaneous fat and visceral fat had reciprocal associations with bone density measures, with subcutaneous fat demonstrating positive associations and visceral fat demonstrating inverse associations.

“We do not yet fully understand the chemical mediators of the associations between regional fat and bone health,” said Misra. “It is possible that inflammatory cytokines, types of signaling molecules used in cellular communication, or hormones like adiponectin or leptin are potential mediators of these associations between fat and bone, but further studies are needed to determine their true impact on bone metabolism.”

Identifying the public health and safety needs of children from low-income communities may be best accomplished through art, report University of Pittsburgh researchers in the current online issue of Progress in Community Health Partnerships: Research, Education and Action. In their paper, researchers describe the success of Visual Voices, an arts-based program that engages community members as partners in research.

The study was based on Visual Voices programs conducted with 22 children ages 8 to 15 in two low-income and predominantly African-American communities in Baltimore and Pittsburgh. During the Visual Voices sessions, participants created paintings and drawings to share their perceptions, both positive and negative, of community safety and violence, as well as their hopes for the future. Afterward, they combined their individual art projects into two “visual voice” exhibits that were publicly displayed in each city.

Michael A. Yonas, Dr.P.H., Visual Voices creator and assistant professor, Department of Family Medicine, University of Pittsburgh School of Medicine, and colleagues at Pitt and the Johns Hopkins Center for Injury Research and Policy, used qualitative research methods to review and code the participants’ art projects for themes. Factors that participants identified as important to safety included school and social networks – family, friends and the local community. Places that they identified as unsafe were corner stores, streets and alleys with poor lighting, and abandoned houses. Other contextual factors identified as unsafe were drugs, smoking, drinking, gambling, guns and violence.

“Community members are experts in their own lives much more so than those who reside outside their communities,” said Dr. Yonas. “Visual Voices helps incorporate residents’ unique expertise into the research process in a non-intrusive and fun way, and creates valuable data about their life experiences.”

Visual Voices is different than surveys or focus groups because it uses tools – crayons, paint and markers – that are familiar to children, and it can lead to in-depth discussions, encourage self-efficacy and help build trusting relationships between academic researchers and the communities they serve, added Dr. Yonas. It also can help experts prioritize public health interventions.

In Pittsburgh, for example, findings were shared with the local police department to develop potential intervention opportunities and to increase law enforcement’s understanding of young peoples’ perceptions of safety.

“The heart of Visual Voices is to ask and listen,” said Jessica G. Burke, Ph.D., study co-author and assistant professor, Department of Behavioral and Community Health Sciences, Pitt’s Graduate School of Public Health. “You need to first ask what it is people care about in order to develop public health interventions that are appropriate for specific communities.”

The Preventive Services Task Force which makes medical-care recommendations based on the latest research has stated that medical professionals warn that children 6 and older should be screened for obesity and be referred to comprehensive weight-management programs.

The team reviewed dozens studies and concluded that obese children who were involved in moderate to high weight-management programs for 25 or more hours over a six-month period could show improvements in their weight. Some of these programs include direction from dietitians, psychologists, exercise trainers and physicians.

The problem seems to be that there are not enough weight-management programs for parents to get their children involved with and it appears it is not a benefit most insurance companies care to pay for. Ned Calonge, chairman of task force and chief medical officer of the Colorado Department of Public Health and Environment. “But now that there is evidence of effectiveness and this new recommendation — that may change.”

Government statistics show that 32% of children and adolescents are obese or overweight and almost 20% of kids ages 6 to 11 and 18% of those ages 12 to 19 are obese. It is important to remember that obese children are at a greater risk of health problems that are related to their obesity such as high cholesterol, blood pressure and diabetes. These children also run a large risk of becoming obese as adults.

Today’s children are thought to be overweight if they fall between the 85th and 94th percentile on body-mass index growth charts. Medical personal who work with overweight kids believe that this currently recommendation is way overdue and that even more options are needed.

“There are millions of obese kids but probably only several hundred centers nationwide offering quality programs that meet the standards outlined in these recommendations,” says Melinda Sothern, director of pediatric obesity research at Louisiana State University Health Sciences Center. “Most of these are affiliated with universities or big hospitals. The programs are expensive if delivered by professionals, but they are less expensive than bariatric surgery later during adolescence.”

She also believes that caregivers and parents need to carefully look at programs to be certain that professionals are educated and trained to work with obese children. “What works for adults doesn’t necessarily work for kids. They have developmental nutritional needs, and exercise has to be fun for them. It can’t be a boot-camp mentality.”

“Part of the problem is that where there are obese children, there are often obese parents,” says Keith Ayoob, associate professor of pediatrics at the Albert Einstein College of Medicine. He believes parents must be involved if they want change to not only happen, but last. “Parents often have to take a hard look at their own eating styles and how they may have morphed into less-than-healthy role models.” If the entire family makes improvements, the payoff is huge, Ayoob says. “A whole family can get healthier when one child does.”

Pediatrician Sandra Hassink, A chair of the American Academy of Pediatrics Obesity Leadership Work Group states, “If a child is obese, parents need to get the child to the doctor to identify weight-related medical conditions such as sleep apnea, diabetes, liver disease, hip and knee problems and depression.”

Greater attention to palliative care for children with cancer is needed to prevent them from suffering unresolved symptoms at the end of life, according to the authors of a study published in the Medical Journal of Australia.

Clinical Associate Prof John Heath, from the Children’s Cancer Centre at the Royal Children’s Hospital, Melbourne, and his co-authors conducted a study of parents of children who died of cancer between 1996 and 2004. Parents from 96 families were interviewed at an average of 4.5 years after a child’s death, with 89 parents subsequently returning self-report questionnaires.

Eighty-four per cent of parents reported that their child had suffered “a lot” or “a great deal” from at least one symptom in their last month of life – most commonly pain (46%), fatigue (43%) and poor appetite (30%).

However, current treatments for these symptoms appeared inadequate, Prof Heath said, with success rates of under 50% for all symptoms and under 20% for symptoms such as fatigue, poor appetite, constipation and diarrhoea.

Prof Heath said a striking difference between the study and previously published international studies was the low proportion of patients who died in hospital (39%) and, more specifically, intensive care units (9%) compared with those who died at home (61%).

Another key finding was the lower level of aggressive, cancer-directed treatment during the end-of-life period (47%) compared with the level (56%) previously reported in a similar cohort in the US.

“Relatively high rates of death at home and low rates of heroic medical interventions suggest a realistic approach to care of children with cancer at the end of life. However, many Australian children who die of cancer suffer from unresolved symptoms,” Prof Heath said.

“Greater attention should be paid to palliative care for these children.

“Given the positive impact that specialist paediatric palliative care services have had overseas, it is hoped their recent introduction in Victoria will improve symptom control and lessen suffering for children dying of cancer,” Prof Heath said.

A new study from Zambia suggests that halting breastfeeding early causes more harm than good for children not infected with HIV who are born to HIV-positive mothers. Stopping breastfeeding before 18 months was associated with significant increases in mortality among these children, according to the study’s findings, described in the Feb. 1, 2010 issue of Clinical Infectious Diseases, and available online now.

The researchers’ initial hypothesis, which proved to be incorrect, suggested that by 4 months of age, children would have passed the critical developmental point when breastfeeding is essential to their survival. However, stopping breastfeeding at 4 months, compared to usual breastfeeding as the child reaches 6 months to 24 months or older, did not decrease mortality or play a significant role in protecting the child from HIV transmission.

These findings were consistent with those for mothers not infected with HIV; longer breastfeeding is necessary to protect children against potentially fatal infectious diseases, especially those prevalent in low-resource settings. To prevent postnatal HIV transmission, however, mothers with HIV should be on antiretroviral drugs.

“Our results help support the recent change in the World Health Organization (WHO) guidelines for prevention of mother-to-child HIV transmission,” said study author Louise Kuhn, PhD, of Columbia University in New York City. “The new guidelines encourage postnatal use of antiretrovirals through the duration of breastfeeding to prevent vertical [mother-to-child] transmission.”