Pediatric Annals

Trend Watch 

Trend Watch

Abstract

Adolescent boys concerned about muscularity who use supplements to enhance their physique are more likely to binge drink and use drugs compared with adolescents who do not use supplements, according to recent study findings published in JAMA Pediatrics.

In addition, the use of these unhealthy products to enhance appearance may not be recognized by their health care provider simply because they are boys, according to Alison E. Field, ScD, of Boston Children’s Hospital, and colleagues.

The researchers analyzed 5,527 adolescent boys aged 12 to 18 years to discover whether concerns about physique and eating disorders were related to drug use, obesity, binge drinking, or high levels of depressive symptoms. The study began in 1999 and patients were followed through 2011.

Field and colleagues found that during the study period:

Participants concerned with thinness but not muscularity were more likely to have depressive symptoms (OR = 2.72; 95% CI, 1.36–5.44). Participants concerned with both thinness and muscularity were more likely to use drugs (OR = 2.13; 95% CI, 1.31–3.46), and those with muscularity concerns who used supplements, growth hormones, or steroids were more likely to binge drink frequently (OR = 2.06; 95% CI, 1.58–2.69) and use drugs (OR = 2.16; 95% CI, 1.49–3.11).

“Muscularity concerns increased with age,” the researchers wrote. “Boys who had high concerns about muscularity and used products to improve their physique were more likely than their peers to start using drugs and binge drinking frequently. In addition, boys with these concerns who were not using potentially unhealthy means to achieve their desired physique were at a slightly lower increased risk of these adverse outcomes. Our results suggest that the failure of most eating disorder assessments to measure concerns with muscularity may result in overlooking a substantial number of males with a potential eating disorder.”

Field AE. JAMA Pediatr. 2013;doi:10.1001/jamapediatrics.2013.2915.

Disclosure: The study was funded in part by the NIH.

Problem-solving education, a cognitive-behavioral intervention, can help reduce parental stress and depressive symptoms after a child is diagnosed with autism spectrum disorder, according to recent study results.

Mothers of children diagnosed with autism spectrum disorder often report stress, depressive symptoms and social isolation. Emily Feinberg, CPNP, ScD, of the Boston University School of Public Health, and colleagues examined 122 mothers of children younger than 6 years who were recently diagnosed with autism spectrum disorder to determine whether problem-solving education helped alleviate stress and symptoms.

Problem-solving education was defined as a brief cognitive intervention delivered in six half-hour individualized session by existing staff or research staff without formal mental health training.

Fifty-nine mothers received six sessions of problem-solving education (intervention) and 63 received usual care (control). Follow-up was conducted after 3 months of treatment.

The intervention group was less likely to report parenting stress (4%) compared with controls (29%; adjusted RR = 0.17; 95% CI, 0.04–0.65). The intervention group was also less likely to report depressive symptoms (6%) compared with controls (22%; adjusted RR = 0.33; 95% CI, 0.1–1.08). At follow-up, the intervention group was more likely to use social coping skills compared with controls (adjusted mean difference, 1.43; 95% CI, 0.4–2.46).

“Future analyses will examine the effect of intervention over a longer follow-up period and allow us to assess whether the intervention worked differently among subgroups of mothers, which is knowledge that could help us better target those most likely to benefit from the intervention,” the researchers wrote in JAMA Pediatrics. “Despite the limited scope of the present analysis, the findings are encouraging. Evidence of successful intervention delivery and positive intervention effects support our ongoing efforts to more definitively test the efficacy of this brief, easily replicated intervention.”…

Concern Over Appearance Among Male Teens Increased Risky Behavior

Adolescent boys concerned about muscularity who use supplements to enhance their physique are more likely to binge drink and use drugs compared with adolescents who do not use supplements, according to recent study findings published in JAMA Pediatrics.

In addition, the use of these unhealthy products to enhance appearance may not be recognized by their health care provider simply because they are boys, according to Alison E. Field, ScD, of Boston Children’s Hospital, and colleagues.

The researchers analyzed 5,527 adolescent boys aged 12 to 18 years to discover whether concerns about physique and eating disorders were related to drug use, obesity, binge drinking, or high levels of depressive symptoms. The study began in 1999 and patients were followed through 2011.

Field and colleagues found that during the study period:

  • 9.2% of participants reported high concern with muscularity but no bulimic behavior;
  • 2.4% reported high concern with muscularity and use of supplements, growth hormones or steroids;
  • 2.5% reported high concern with thinness but no bulimic behavior;
  • 6.3% reported high concern with thinness and muscularity.

Participants concerned with thinness but not muscularity were more likely to have depressive symptoms (OR = 2.72; 95% CI, 1.36–5.44). Participants concerned with both thinness and muscularity were more likely to use drugs (OR = 2.13; 95% CI, 1.31–3.46), and those with muscularity concerns who used supplements, growth hormones, or steroids were more likely to binge drink frequently (OR = 2.06; 95% CI, 1.58–2.69) and use drugs (OR = 2.16; 95% CI, 1.49–3.11).

“Muscularity concerns increased with age,” the researchers wrote. “Boys who had high concerns about muscularity and used products to improve their physique were more likely than their peers to start using drugs and binge drinking frequently. In addition, boys with these concerns who were not using potentially unhealthy means to achieve their desired physique were at a slightly lower increased risk of these adverse outcomes. Our results suggest that the failure of most eating disorder assessments to measure concerns with muscularity may result in overlooking a substantial number of males with a potential eating disorder.”

Field AE. JAMA Pediatr. 2013;doi:10.1001/jamapediatrics.2013.2915.

Disclosure: The study was funded in part by the NIH.

Brief Intervention Reduced Parents’ Stress After Child Autism Diagnosis

Problem-solving education, a cognitive-behavioral intervention, can help reduce parental stress and depressive symptoms after a child is diagnosed with autism spectrum disorder, according to recent study results.

Mothers of children diagnosed with autism spectrum disorder often report stress, depressive symptoms and social isolation. Emily Feinberg, CPNP, ScD, of the Boston University School of Public Health, and colleagues examined 122 mothers of children younger than 6 years who were recently diagnosed with autism spectrum disorder to determine whether problem-solving education helped alleviate stress and symptoms.

Problem-solving education was defined as a brief cognitive intervention delivered in six half-hour individualized session by existing staff or research staff without formal mental health training.

Fifty-nine mothers received six sessions of problem-solving education (intervention) and 63 received usual care (control). Follow-up was conducted after 3 months of treatment.

The intervention group was less likely to report parenting stress (4%) compared with controls (29%; adjusted RR = 0.17; 95% CI, 0.04–0.65). The intervention group was also less likely to report depressive symptoms (6%) compared with controls (22%; adjusted RR = 0.33; 95% CI, 0.1–1.08). At follow-up, the intervention group was more likely to use social coping skills compared with controls (adjusted mean difference, 1.43; 95% CI, 0.4–2.46).

“Future analyses will examine the effect of intervention over a longer follow-up period and allow us to assess whether the intervention worked differently among subgroups of mothers, which is knowledge that could help us better target those most likely to benefit from the intervention,” the researchers wrote in JAMA Pediatrics. “Despite the limited scope of the present analysis, the findings are encouraging. Evidence of successful intervention delivery and positive intervention effects support our ongoing efforts to more definitively test the efficacy of this brief, easily replicated intervention.”

Feinberg E. JAMA Pediatr. 2013;doi:10.1001/jamapediatrics.2013.3445.

Disclosure: The study was funded in part by the Maternal and Child Health Bureau.

Poor Developmental Outcomes Linked to Parental Violence, Psychological Distress

Children with known exposures to intimate partner violence and/or parental psychological distress should be screened for developmental delay, according to recent study findings published in Pediatrics.

Amy Lewis Gilbert, JD, MPH, and colleagues from the Children’s Health Services section of the Indiana University School of Medicine examined parental reports of intimate partner violence (IPV) and/or parental psychological distress (PPD) to see whether there is an association with developmental milestone failures within the first 72 months of a child’s life.

The study included 16,595 children. Parents of 88 participants reported both IPV and PPD, and these participants were more likely to fail at least one developmental milestone for language (adjusted OR = 2.1; 95% CI, 1.3–3.3), personal-social (aOR = 1.9; 95% CI, 1.2–2.9), and gross motor (aOR = 3; 95% CI, 1.8–5). The parents of 2% of participants reported exposure to IPV only, which was associated with failing at least one developmental milestone for language (aOR=1.4; 95% CI, 1.1–1.9), personal-social (aOR = 1.7; 95% CI, 1.4–2.2), and fine motor-adaptive (aOR = 1.7; 95% CI, 1–2.7). Strong associations were also shown for language (aOR = 1.5; 95% CI, 1.3–1.7), personal-social (aOR = 1.6; 95% CI, 1.5–1.8), gross motor (aOR = 1.6; 95% CI, 1.4–1.8), and fine motor-adaptive (aOR = 1.6; 95% CI, 1.3–2.0) milestones among participants whose parents reported PPD only (11.6%).

“Children with known exposures to either IPV or PPD, such as depression or anxiety, should be actively monitored for developmental delay so that referrals for intervention may be made at the earliest point possible,” Gilbert told Pediatric Annals. “Likewise, children that fail to attain important developmental milestones should be screened for IPV and PPD so that these risk factors may also be addressed.”

Gilbert AL. Pediatrics. 2013;doi:10.1542/peds.2013-1020.

Disclosure: The study was funded in part by grants from the Agency for Healthcare Research and Quality, NIH, and the National Library of Medicine.

Early Puberty Tied to Obesity

New data published in Pediatrics bolster scientific evidence indicating that the onset of puberty is occurring at younger ages in girls, with results pointing to obesity as a strong predictor for early breast development.

“The impact of earlier maturation in girls has important clinical implications involving psychosocial and biologic outcomes,” study researcher Frank Biro, MD, of the division of adolescent medicine at Cincinnati Children’s Hospital Medical Center, said in a press release. “The current study suggests clinicians may need to redefine the ages for both early and late maturation in girls.”

BMI Effect on Pubertal Onset

For their study, Biro and colleagues longitudinally followed 1,239 girls from the three puberty study sites of the Breast Cancer and the Environment Research Program (BCERP) — San Francisco Bay Area, Cincinnati, and New York City — for a mean of 4.3 years from 2004 to 2011. They evaluated sexual maturity via a standardized method based on Tanner staging that used observation and palpation to evaluate breast development. Age at enrollment ranged from 6 to 8 years.

Results indicated that age at onset of breast development varied by several factors, including race/ethnicity, BMI, and geographic location. Median ages at onset of breast stage 2 were 8.8 years for black girls, 9.3 years for Hispanic girls, and 9.7 years for white and Asian girls. The finding that black girls experienced breast development at an earlier age than white girls is consistent with previous findings, according to the researchers.

However, regardless of race/ethnicity, BMI appeared to be the strongest predictor of age at onset of breast development. Girls with BMI greater than the 50th percentile were more likely to reach breast stage 2 compared with those with BMI less than the 50th percentile (P = .001 for trend), and girls with BMI in the 85th percentile or greater matured earlier than those with BMI less than the 85th percentile, according to the study findings. Additionally, BMI accounted for 14.2% of variance of all the covariates included in the researchers’ model for analysis.

Of those included in the study, 39% of black, 44% of Hispanic, 26% of white, and 12% of Asian girls had a BMI in the 85th percentile or greater.

When compared with two large cross-sectional studies — Pediatric Research in Office Settings and National Health and Nutrition Examination Survey III — conducted 10 to 20 years ago, the researchers found that breast development occurred earlier among white girls but not black girls in the BCERP.

Despite the association between higher BMI and earlier onset of puberty, the exact mechanisms by which they are linked remains unclear and requires further study, the researchers wrote.

Early Puberty not the ‘New Normal’

In an accompanying commentary, Marcia E. Herman-Giddens, PA, MPH, DrPH, of the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, said the study’s findings add to the body of evidence showing that puberty is occurring at younger ages, but they also raise many questions, including the role that other factors besides obesity play in early puberty.

“Each individual girl is exposed to multiple factors in today’s environment, many not present decades ago, that may potentially influence her pubertal onset. Given that the exact trigger for pubertal initiation is still unknown, we can hardly fully understand the interactions of factors known to affect puberty, even with current sophisticated statistical modeling,” Herman-Giddens wrote.

Because of the detrimental psychosocial effects, however, Herman-Giddens said clinicians should not accept premature development as the “new normal” due to these study results, but emerging data on early puberty have at least spurred researchers to further investigate the potential causes, which is a major step forward.

“With each new study in the past two decades, we hope the age of ‘early puberty’ has bottomed out,” Herman-Giddens wrote. “When each ‘new study’ has been published, however, we find the trend toward early puberty has continued. Fortunately, we have moved beyond controversy about the data and are responding to the wake-up call.”

Biro FM. Pediatrics. 2013;doi:10.1542/peds.2012-3773.

Herman-Giddens ME. Pediatrics. 2013;doi:10.1542/peds.2013-3058.

Disclosure: The researchers and Herman-Giddens report no relevant financial disclosures.

Joint Guidelines Updated for Treatment of Opportunistic Infections in Children with HIV

Guidelines for the prevention and treatment of opportunistic infections among children exposed to HIV and children with HIV have recently been updated for the first time since 2009. They were released as a joint effort by the NIH, CDC, HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the AAP.

The guidelines are aimed at providing physicians and health care workers with information for treating opportunistic pathogens that occur in the United States and ones that can be acquired during international travel in children with HIV and children exposed to HIV. Each section includes epidemiology, clinical presentation, diagnosis of the infection in children, prevention of exposure, prevention of first episode of the disease, discontinuation of primary prophylaxis after immune reconstitution, treatment of disease, monitoring for adverse effects during treatment, management of treatment failure, prevention of disease recurrence, and discontinuation of secondary prophylaxis after immune reconstitution.

Major changes to the guidelines include:

  • More emphasis on antiretroviral therapy for the prevention and treatment of opportunistic infections, especially for those without a specific therapy;
  • More information on the management and diagnosis of immune reconstitution inflammatory syndrome;
  • Potential drug-drug interactions through information about managing ART in children with opportunistic infections;
  • Immunization recommendations updated for the pneumococcal, HPV, meningococcal and rotavirus vaccines;
  • New sections on influenza, giardiasis and isosporiasis;
  • Deletion of sections on aspergillosis, bartonellosis, human herpes virus-6, human herpes virus-7 infections;
  • New updates for recommendations on the discontinuation of opportunistic infection prophylaxis following immune reconstitution in children.

Mothers with HIV are more likely to have coinfections with opportunistic infections than mothers without HIV, which increases the risk of passing on the infections to their children. The guidelines also cover treatment of opportunistic infections for children, both with HIV and without, born to mothers with HIV.

To view the complete guidelines, go to aidsinfo.nih.gov. The guidelines also were published in a supplement to The Pediatric Infectious Disease Journal.

Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children. Available at: http://aidsinfo.nih.gov/guidelines/html/5/pediatric-oi-prevention-and-treatment-guidelines/0. Accessed Nov. 12, 2013.

Disclosure: See guidelines for a full list of disclosures.

Nurse Home Visits Decreased Infant Emergency Care

Home visits from a nurse, although expensive, decreased emergency care episodes compared with children without home visits, according to study results published in Pediatrics.

Kenneth A. Dodge, PhD, and colleagues from the Center for Child and Family Policy at Duke University examined Durham Connect, a program that provides home visits for newborns and their parents in Durham, N.C. Through the program, nurses visit new parents soon after the newborn comes home from the hospital, check the health of the mother and newborn, and offer tips related to breast-feeding and child care. They also screen for potential maternal depression. During a series of one to three visits, the nurses can also link families who need extra help to the appropriate community services.

All 4,777 infants born in Durham County between July 1, 2009, and Dec. 31, 2010, were randomly assigned: even birth-date families were given home visits and odd birth-date families were the controls.

Dodge and colleagues found that the intervention group had 50% fewer emergency care episodes in the first year of life compared with the control group (P < .001).

“This preventive impact holds for all groups of families studied, including both privately insured and Medicaid or uninsured families, suggesting the benefits of providing short-term postnatal nurse home visiting universally in a community,” the researchers wrote. “This program complements more intensive home visiting models by serving as a screening and triage tool that ensures optimal matching of families with long-term services only as needed.”

Dodge KA. Pediatrics. 2013;doi:10.1542/peds.2013-1021M.

Disclosure: The study was funded in part by The Duke Endowment, NIH, and the Pew Center on the States. The researchers report no relevant financial disclosures.

10.3928/00904481-20131122-02

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