Pediatric Annals

Trend Watch 

Trend Watch

Abstract

Peer victimization of gay, lesbian, and bisexual adolescents in England was highest as students entered high school but decreased over subsequent years, according to study results recently published in Pediatrics.

“On average, bullying decreases with age, regardless of sexual orientation and gender,” study researcher Joseph P. Robinson, PhD, of the University of Illinois at Urbana-Champaign, told Pediatric Annals. “However, relative rates of bullying — that is, comparing rates of bullying for [LGB] youth with those for heterosexual youth — suggest that it gets relatively better for lesbian and bisexual females, compared to heterosexual females, while it gets relatively worse for gay and bisexual males, compared to heterosexual males. This suggests we need to better understand why relative rates of bullying increase for gay and bisexual males.”

Robinson and colleagues examined rates of peer victimization among a nationally representative sample of 4,135 adolescents in England, 187 (4.5%) of whom self-identified as lesbian, gay, and bisexual (LGB). Data were collected in seven waves, beginning when students were aged 13 and 14 years. During interviews, students and their parents reported on specific forms of peer victimization, including name calling, threats of physical violence, and acts of physical violence. The researchers also assessed students for emotional distress.

According to Robinson and colleagues, 57% of lesbian and bisexual female students reported being bullied at the age of 13 or 14 years, but only 6% of these students reported being bullied at the age of 20 or 21 years. For gay and bisexual male students, bullying declined from 52% to 9%.

Although LGB students experienced an overall reduction in bullying, gay and bisexual male students were still more likely to be bullied vs. heterosexual boys; lesbian and bisexual female students were no more likely to be bullied than heterosexual female students.

Results also indicated that gay and bisexual male students (P = .002) and lesbian and bisexual female students (P = .001) demonstrated significantly higher levels of emotional distress after high school than their heterosexual peers. Peer victimization and emotional distress early on accounted for approximately 50% of LGB students’ emotional distress in later years (P < .015).

“This suggests that reducing bullying during high school and recognizing and reducing early signs of emotional distress may help to reduce the LGB-heterosexual disparity in emotional distress in early adulthood,” Robinson said.

Robinson JP. Pediatrics. 2013;doi:10.1542/peds.2012-2595.

Disclosure: Robinson reports no relevant financial disclosures.

Disruptive mood dysregulation disorder — to be included in the DSM-5 — was found to be relatively uncommon after early childhood, researchers reported in the American Journal of Psychiatry. However, the disorder frequently occurred with other psychiatric disorders, including depression and oppositional defiant disorder.

Disruptive mood dysregulation disorder (DMDD) diagnosis will be limited to children aged 6 years or younger. Criteria include severe outbursts combined with persistent irritability. Symptom onset must occur before the age of 10 years and be present for at least 12 months.

William E. Copeland, PhD, of Duke University, and colleagues examined the prevalence rates of DMDD among 3,258 children and adolescents from three separate community studies: Duke Preschool Anxiety Study (participants aged 2 to 5 years); Great Smoky Mountains Study (participants aged 9 to 13 years); and Caring for Children in the Community (participants aged 9 to 17 years). Although none of the studies were designed to measure DMDD, the researchers were able to determine the disorder’s prevalence across the three study populations since its criteria overlap entirely with those of other common disorders.

The 3-month prevalence rates of DMDD ranged from 0.8% to 3.3%, with the highest rate occurring among preschoolers. DMDD frequently overlapped with all common psychiatric disorders,…

LGB Victimization Diminished after High School

Peer victimization of gay, lesbian, and bisexual adolescents in England was highest as students entered high school but decreased over subsequent years, according to study results recently published in Pediatrics.

“On average, bullying decreases with age, regardless of sexual orientation and gender,” study researcher Joseph P. Robinson, PhD, of the University of Illinois at Urbana-Champaign, told Pediatric Annals. “However, relative rates of bullying — that is, comparing rates of bullying for [LGB] youth with those for heterosexual youth — suggest that it gets relatively better for lesbian and bisexual females, compared to heterosexual females, while it gets relatively worse for gay and bisexual males, compared to heterosexual males. This suggests we need to better understand why relative rates of bullying increase for gay and bisexual males.”

Robinson and colleagues examined rates of peer victimization among a nationally representative sample of 4,135 adolescents in England, 187 (4.5%) of whom self-identified as lesbian, gay, and bisexual (LGB). Data were collected in seven waves, beginning when students were aged 13 and 14 years. During interviews, students and their parents reported on specific forms of peer victimization, including name calling, threats of physical violence, and acts of physical violence. The researchers also assessed students for emotional distress.

According to Robinson and colleagues, 57% of lesbian and bisexual female students reported being bullied at the age of 13 or 14 years, but only 6% of these students reported being bullied at the age of 20 or 21 years. For gay and bisexual male students, bullying declined from 52% to 9%.

Although LGB students experienced an overall reduction in bullying, gay and bisexual male students were still more likely to be bullied vs. heterosexual boys; lesbian and bisexual female students were no more likely to be bullied than heterosexual female students.

Results also indicated that gay and bisexual male students (P = .002) and lesbian and bisexual female students (P = .001) demonstrated significantly higher levels of emotional distress after high school than their heterosexual peers. Peer victimization and emotional distress early on accounted for approximately 50% of LGB students’ emotional distress in later years (P < .015).

“This suggests that reducing bullying during high school and recognizing and reducing early signs of emotional distress may help to reduce the LGB-heterosexual disparity in emotional distress in early adulthood,” Robinson said.

Robinson JP. Pediatrics. 2013;doi:10.1542/peds.2012-2595.

Disclosure: Robinson reports no relevant financial disclosures.

DMDD likely Atypical after Early Childhood

Disruptive mood dysregulation disorder — to be included in the DSM-5 — was found to be relatively uncommon after early childhood, researchers reported in the American Journal of Psychiatry. However, the disorder frequently occurred with other psychiatric disorders, including depression and oppositional defiant disorder.

Disruptive mood dysregulation disorder (DMDD) diagnosis will be limited to children aged 6 years or younger. Criteria include severe outbursts combined with persistent irritability. Symptom onset must occur before the age of 10 years and be present for at least 12 months.

William E. Copeland, PhD, of Duke University, and colleagues examined the prevalence rates of DMDD among 3,258 children and adolescents from three separate community studies: Duke Preschool Anxiety Study (participants aged 2 to 5 years); Great Smoky Mountains Study (participants aged 9 to 13 years); and Caring for Children in the Community (participants aged 9 to 17 years). Although none of the studies were designed to measure DMDD, the researchers were able to determine the disorder’s prevalence across the three study populations since its criteria overlap entirely with those of other common disorders.

The 3-month prevalence rates of DMDD ranged from 0.8% to 3.3%, with the highest rate occurring among preschoolers. DMDD frequently overlapped with all common psychiatric disorders, especially with depressive disorders (ORs ranging between 9.9 and 23.5) and oppositional defiant disorder (ORs ranging between 52.9 and 103). Severe tantrums (80.8%, 45.7%, and 49%, respectively) and negative mood (21.1%, 12.8%, and 8.2%, respectively) were common across all three study populations.

DMDD occurred with another disorder 62% to 92% of the time, and it occurred with both an emotional and behavioral disorder 32% to 68% of the time. Youth with DMDD had more school suspensions, greater use of mental health services, and lived in greater poverty.

“This early look at disruptive mood dysregulation disorder suggests that it meets common standards of psychiatric ‘caseness’ and that it identifies a group of children with severe emotional and behavioral dysregulation,” the researchers wrote. “Its relatively low prevalence and high levels of service utilization moderate worries about ‘pathologizing’ normal behavior, although the core symptoms are common and its rarity comes from strict application of frequency, duration, and cross-context criteria.”

Copeland WE. Am J Psychiatry. 2013;170:173–179.

Disclosure: The researchers report no relevant financial disclosures.

ACIP Recommends Meningococcal Vaccine for Infants

The Advisory Committee on Immunization Practices has recommended vaccination against meningococcal serogroups C and Y for children aged 6 weeks to 18 months who are at increased risk for meningococcal disease.

According to findings in a recent Morbidity and Mortality Weekly Report, a conjugate vaccine containing meningococcal groups C and Y and Haemophilus type b tetanus toxoid (Hib-MenCY-TT; MenHibrix, GlaxoSmithKline Biologicals), licensed by the US FDA in June, is for active immunization against disease caused by Hib and meningococcal serogroups C and Y. Before licensure of this vaccine, there were no meningococcal conjugate vaccines indicated for use in infants aged 2 to 8 months.

The vaccine is a four-dose series indicated for infants at increased risk for meningococcal disease. The first dose can be given when the infant is as young as 6 weeks, and the last as late as age 18 months. Infants at increased risk include those with recognized persistent complement pathway deficiencies and infants who have anatomic or functional asplenia, including sickle cell disease. The vaccine can also be used for infants aged 6 weeks to 18 months who reside in communities with serogroups C and Y meningococcal disease outbreaks.

CDC. MMWR. 2013;62;52–54.

Disclosure: The researchers report no relevant financial disclosures.

Hydrocolloid Mask Effectively Treated Children’s Facial Atopic Eczema

Face masks made from hydrocolloid dressing, including one with topical corticosteroids, were effective in treating recurring atopic eczema in pediatric patients, researchers have found.

“We know that eroded skin hurts, and that covering it improves discomfort very quickly,” Marius Rademaker, DM, BM, FRCP, FRACP, clinical director of the dermatology unit, Waikato District Health Board, Hamilton, New Zealand, told Pediatric Annals. “The traditional face masks were too difficult to use, so it seemed logical to use a proprietary hydrocolloid dressing.”

Rademaker studied three children (aged 3 to 4 years; two girls) with significant facial atopic eczema who were treated with face masks made with adhesive hydrocolloid dressings. Patients had experienced atopic eczema from ages 6 months to 9 months and had been treated with emollients and topical corticosteroids, including betamethasone valerate to clobetasol propionate on the trunk and limbs, and corticosteroids, including 1% hydrocortisone cream and 0.1% hydrocortisone butyrate, on the face.

Patients had one to four episodes of secondary infection with Staphylococcus aureus, and one patient experienced facial eczema herpeticum. Appropriate antivirals or antibiotics were used to treat symptoms.

Dressings, composed of three pieces formed to cover the forehead and cheeks, lasted 3 to 4 days before replacement. Itch or soreness symptoms were controlled within hours of application. Patients wore the masks for 5 to 14 days, with major clearing of the eczema. One patient underwent a single application of betamethasone valerate cream 30 minutes before the first face mask. Facial eczema remained in remission for more than 3 months despite continued eczema on the trunk and limbs.

Three days after treatment, one patient redeveloped eczema herpeticum, which was treated with oral acyclovir followed by 4 more days of face-mask treatment.

“By using a hydrocolloid dressing over several days, one can minimize the effects of rubbing,” Rademaker said. “It is very quick and easy to fashion the dressing, with almost instantaneous improvement in discomfort.”

Rademaker M. Australas J Dermatol. 2012;doi:10.1111/ajd.12004.

Disclosure: Rademaker reports no relevant financial disclosures.

Check List ☑

According to the Centers for Disease Control and Prevention (CDC), more support for breast-feeding mothers is needed, since less than half (45%) still breast-feed their infants after 6 months; and less than a quarter (23%) breast-feed for a year.

“Breast-feeding is good for the mother and for the infant — and the striking news here is, hundreds of thousands more babies are being breast-fed than in past years, and this increase has been seen across most racial and ethnic groups,” CDC Director Thomas R. Frieden, MD, MPH, said in a statement. “Despite these increases, many mothers who want to breast-feed are still not getting the support they need from hospitals, doctors, or employers. We must redouble our efforts to support mothers who want to breast-feed.”

The American Academy of Pediatrics (AAP) guidelines, updated in 2012, state that infants should be breast-fed exclusively for a minimum of 6 months, with the addition of solid foods at 6 months. The AAP also recommends that babies should be breast-fed for at least 1 year.

“One of the many reasons for [the emphasis on breast-feeding] is that mother’s milk contains live cells that fight infection in the baby,” Nancy Mohrbacher, IBBLCL, FILCA, lactation consultant and author of Breastfeeding Solutions, told Pediatric Annals.

Mohrbacher also said that when a mother becomes ill, her body begins making antibodies specific to her illness, which go into her milk and protect the infant. “If she were to stop breast-feeding while she was ill, her baby – who was already exposed to its mother’s illness before the mother even knew she was sick – would have no protection,” Mohrbacher said.

When discussing breast-feeding with mothers, particularly those who are hesitant to breast-feed, Mohrbacher suggests pediatricians emphasize:

  • ☑ Breast-feeding is the biological norm for humans.

  • ☑ It offers greater protection from infections than formula.

  • ☑ The infant receives a large proportion of its essential nutrients from breast milk.

  • ☑ Growth charts, including those issued by the World Health Organization, are being redesigned with breast-fed babies as the benchmark.

CDC. More Mothers are Breastfeeding. Available at: www.cdc.gov/media/releases/2013/p0207_breast_feeding.html.

American Academy of Pediatrics. Pediatrics. 2012;129(3):e827–841.

WHO. How different are the new standards from the old growth charts? Available at: www.who.int/childgrowth/faqs/how_different/en/index.html.

10.3928/00904481-20130222-02

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