Fewer children at risk for deficient vitamin D

Under new guidelines from the Institute of Medicine, the estimated number of children who are at risk of having insufficient or deficient levels of vitamin D is drastically reduced from previous estimates, according to a Loyola University Chicago Stritch School of Medicine study.

The study, led by Holly Kramer, MD, MPH, and Ramon Durazo-Arvizu, PhD, is published online ahead of print in the Journal of Pediatric Endocrinology and Metabolism.

New Institute of Medicine guidelines say most people get sufficient vitamin D when their blood levels are at or above 20 nanograms per milliliter (ng/mL). The Pediatric Endocrine Society has a similar guideline. However, other guidelines recommend vitamin D levels above 30 ng/mL.

Loyola researchers studied vitamin D data from a nationally representative sample of 2,877 U.S. children and adolescents ages 6 to 18 who participated in the National Health and Nutrition Examination Survey.

The study found that under the Institute of Medicine guidelines, 10.3 percent of children ages 6 to 18 are at risk of inadequate or deficient vitamin D levels. (This translates to an estimated 5.5 million children.)

By comparison, a 2009 study in the journal Pediatrics, which defined sufficient vitamin D levels as greater than 30 ng/mL, found that an estimated 70 percent of people ages 1 to 21 had deficient or insufficient vitamin D levels.

Under previous guidelines, millions of children who had vitamin D levels between 20 and 30 ng/mL would have needed supplementation. Under the Institute of Medicine guidelines, children in this range no longer need to take vitamin D supplements.

The new study found that children at risk of vitamin D deficiency under the Institute of Medicine guidelines are more likely to be overweight, female, non-white and between the ages of 14 and 18.

The Institute of Medicine's new vitamin D guidelines are based on nearly 1,000 published studies and testimony from scientists and other experts. The IOM found that vitamin D is essential to avoid poor bone health, such as rickets. But there have been conflicting and mixed results in studies on whether vitamin D can also protect against cancer, heart disease, autoimmune diseases and diabetes. Moreover, excessive vitamin D can damage the kidneys and heart, the IOM found.

Story Source:

The above story is based on materials provided by Loyola University Health System. Note: Materials may be edited for content and length.

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Over 23 million children to be vaccinated in mass polio immunization campaign across Middle East

9 December 2013 | CAIRO, AMMAN - The largest-ever immunization response in the Middle East is under way this week, aiming to vaccinate more than 23 million children against polio in Syria and neighbouring countries over the coming weeks.

The campaign is a crucial part of the response to an outbreak of the virus-borne disease in Syria, where 17 cases have so far been confirmed, and to the detection of the virus in environmental samples in other parts of the Middle East.

In order to stop the outbreak and prevent further spread, organizers aim to vaccinate, repeatedly over the next few months, all children under the age of 5, whether they are living at home or displaced by conflict. Depending on the area, vaccination will be offered at fixed sites at populous locations or by going from house to house. The activities are carried out by national and local health authorities supported by UNICEF, WHO, the Syrian Arab Red Crescent and other partners.

Inside Syria, the campaign aims to reach 2.2 million children, including those who live in contested areas and those who were missed in an earlier campaign. Many children in Syria remain inaccessible, particularly those trapped in sealed off areas or living in areas where conflict is ongoing.

Despite the gaps in coverage, initial information suggests that vaccine is getting to more areas of Syria than has so far been the case for health interventions delivered as part of the larger ongoing humanitarian effort. In parallel with the vaccination effort, work is going on to bolster systems for verifying coverage data in upcoming campaigns inside the war-torn country.

“All Syrian children should be protected from disease,” noted Dr. Ala Alwan, Regional Director, WHO Eastern Mediterranean Region. “To eradicate polio, we need to eradicate any reason for failing to reach children. We appeal to all parties of the conflict in Syria to cooperate and facilitate pauses in hostilities over the coming 6 months to allow vaccination campaigns to reach all children.”

“As if children in Syria had not suffered enough, they now have to contend with yet another threat to their health and well-being,” said Maria Calivis, UNICEF Regional Director for the Middle East and North Africa. “The current polio vaccination efforts are a huge undertaking by many partners, but we can only halt the spread of the virus if we reach those children who have remained out of reach."

Over the coming months, UNICEF is planning to deliver 10 million doses of polio vaccine to Syria. The first shipment of 2 million vaccines arrived in Damascus on Friday 29 November.

The total cost to UNICEF and WHO of supporting the seven-country polio response from November through April is US$ 39 million, based on a strategic plan developed for the Middle East.

Note to editors

As of 26 November, 17 children have been paralyzed by polio in Syria: 15 of these children are in the contested governorate of Deir Ez Zour, 1 is in Aleppo and another in Douma, near Damascus. Prior to this outbreak, no polio cases have been recorded in Syria since 1999. The risk of spread to countries in the region and beyond is considered high, and health authorities from 21 countries have declared a public health emergency. Further polio immunization campaigns will be repeated across the region. In Syria, they will be carried out at monthly intervals until April 2014.

Genetically-related polioviruses, which originated in Pakistan, have also been detected in sewage samples in Egypt in December 2012, and in Israel and the West Bank and Gaza Strip earlier in 2013.

Inside Syria and for the past 2 years, immunization activities have been significantly constrained by ongoing conflict. Cold chain equipment in many districts has been lost and many mobile health teams have not been able to perform regular visits. This has led to missing out on vaccinating between 500?000–700?000 children in these areas.

For more information, please contact:

Rana Sidani
WHO Regional Office in Cairo
Telephone: +20 109 975 6506
E-mail: sidanir@who.int

Sona Bari
WHO Geneva
Telephone: +41 79 475 5511
E-mail: baris@who.int

Simon Ingram
UNICEF Regional Office for the Middle East and North Africa in Amman
Telephone: +962 79 590 4740
E-mail: singram@unicef.org

Najwa Mekki
UNICEF Regional Office for the Middle East and North Africa in Amman
Telephone: +962 79 573 2745
E-mail: nmekki@unicef.org

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Children in typhoon-hit Tacloban, Philippines, receive vaccines against measles, polio

26 November 2013 | Tacloban, Philippines - Children in Tacloban - the city hit hardest by Typhoon Haiyan - were today vaccinated against measles and polio in the first phase of a mass campaign by the Government of the Philippines with support from WHO, the United Nations Children's Fund (UNICEF) and other partners. They also received Vitamin A supplements to help improve their immunity against infections.

30 000 children targeted in first phase

Over 30?000 children are expected to be reached by the campaign which is taking place at fixed sites in evacuation centres and in communities using mobile health teams.

"It is virtually unprecedented that within two-and-a-half weeks of a disaster of this scale, with this level of devastation and these logistical challenges, that a mass vaccination campaign is already rolling out."

Dr Julie Hall, WHO Representative in the Philippines

The vaccination drive in Tacloban is the first phase of a campaign targeting children aged less than 5 years in all the typhoon-affected areas. Fifteen teams (10 foreign and 5 national) including volunteers from the Department of Health, the Philippines Red Cross and other non-governmental organisations, were in locations across Tacloban giving vaccines today. The first to receive them were children in 20 evacuation centres, such as San Jose Elementary School, where more than 300 families currently live in conditions that can heighten the risk of infectious diseases.

"The children of Tacloban need all the protection they can get right now," says Angela Kearney, UNICEF Coordinator for the Emergency Response in Tacloban. "Disease is a silent predator, but we know how to prevent it and we will do everything that we can."

WHO and UNICEF coordinate vaccine supply and establish cold chain

At the Government’s request, UNICEF purchased over US$ 2 million worth of vaccines to replenish in-country stocks now being used for the campaign. In addition, UNICEF and WHO are helping to re-establish the broken cold chain, which is critical in keeping vaccines at the right temperature.

"WHO and UNICEF staff hand-carried supplies from Manila to Tacloban, coordinated teams to give the vaccines and trained them on how to do it under these difficult circumstances. It is virtually unprecedented that within two-and-a-half weeks of a disaster of this scale, with this level of devastation and these logistical challenges, that a mass vaccination campaign is already rolling out," says Dr Julie Hall, WHO Representative in the Philippines.

During the campaign children being immunized are also screened for malnutrition by measuring their mid-upper arm circumference which will indicate if they are undernourished and require referral for treatment.

For further information, please contact:

Nyka Alexander
Communications Officer
WHO, Manila
Telephone: +63 906 493 5097
E-mail: alexandern@wpro.who.int

Gregory Hartl
Coordinator, News and Social Media
WHO, Geneva
Telephone: +41 79 203 6715
E-mail: hartlg@who.int

Zafrin Chowdhury
UNICEF, Tacloban
Telephone: + 63 917 867 8366
E-mail: zchowdhury@unicef.org

Kate Donovan
UNICEF, Tacloban
Telephone: + 1 212 303 7984,
Mobile: + 1 917 3781 2128
E-mail: kdonovan@unicef.org

Denise Shepherd-Johnson
UNICEF, Manila
Telephone: + 63 917 464 7028
E-mail: dshepherdjohnson@unicef.org

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Messy children make better learners: Toddlers learn words for nonsolids better when getting messy in a highchair

Dec. 2, 2013 — Attention, parents: The messier your child gets while playing with food in the high chair, the more he or she is learning.

Researchers at the University of Iowa studied how 16-month-old children learn words for nonsolid objects, from oatmeal to glue. Previous research has shown that toddlers learn more readily about solid objects because they can easily identify them due to their unchanging size and shape. But oozy, gooey, runny stuff? Not so much.

New research shows that changes if you put toddlers in a setting they know well, such as shoving stuff in their mouths. In those instances, word learning increases, because children at that age are "used to seeing nonsolid things in this context, when they're eating," says Larissa Samuelson, associate professor in psychology at the UI who has worked for years on how children learn to associate words with objects. "And, if you expose them to these things when they're in a highchair, they do better. They're familiar with the setting and that helps them remember and use what they already know about nonsolids."

In a paper published in the journal Developmental Science, Samuelson and her team at the UI tested their idea by exposing 16-month-olds to 14 nonsolid objects, mostly food and drinks such as applesauce, pudding, juice, and soup. They presented the items and gave them made-up words, such as "dax" or "kiv." A minute later, they asked the children to identify the same food in different sizes or shapes. The task required the youngsters to go beyond relying simply on shape and size and to explore what the substances were made of to make the correct identification and word choice.

Not surprisingly, many children gleefully dove into this task by poking, prodding, touching, feeling, eating -- and yes, throwing -- the nonsolids in order to understand what they were and make the correct association with the hypothetical names. The toddlers who interacted the most with the foods -- parents, interpret as you want -- were more likely to correctly identify them by their texture and name them, the study determined. For example, imagine you were a 16-month-old gazing at a cup of milk and a cup of glue. How would you tell the difference by simply looking?

"It's the material that makes many nonsolids," Samuelson notes, "and how children name them."

The setting matters, too, it seems. Children in a high chair were more apt to identify and name the food than those in other venues, such as seated at a table, the researchers found.

"It turns out that being in a high chair makes it more likely you'll get messy, because kids know they can get messy there," says Samuelson, the senior author on the paper. The authors say the exercise shows how children's behavior, environment (or setting) and exploration help them acquire an early vocabulary -- learning that is linked to better later cognitive development and functioning.

"It may look like your child is playing in the high chair, throwing things on the ground, and they may be doing that, but they are getting information out of (those actions)," Samuelson contends. "And, it turns out, they can use that information later. That's what the high chair did. Playing with these foods there actually helped these children in the lab, and they learned the names better."

"It's not about words you know, but words you're going to learn," Samuelson adds. Lynn Perry, who helped design the study and analyze the data as part of her doctoral studies at the UI, is the first author on the paper. Johanna Burdinie, who was an UI undergraduate during the project, is a contributing author.

The National Institutes of Health (grant number: R01 HD045713) funded the research. Burdinie was funded by a fellowship from the Iowa Center for Research for Undergraduates.

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WHO issues new guidance for treating children with severe acute malnutrition

27 November 2013 | GENEVA - WHO today released new treatment guidelines for the almost 20 million children under-five worldwide who have severe acute malnutrition.

Severe acute malnutrition is when children suffer severe wasting that may or may not be accompanied by swelling of the body from fluid retention. It occurs when infants and children do not have adequate energy, protein and micronutrients in their diet, combined with other health problems such as recurrent infections. It is diagnosed when the circumference of the upper arm is less than 115 mm or when the weight for height of a child is severely reduced.

Children with severe acute malnutrition are among the most vulnerable people in the world. They are very thin: most of their fat and muscle has been used by their bodies to stay alive.

Main recommendations

The updated WHO guidelines recommend that children with severe acute malnutrition who do not have health complications that require hospitalization, receive special, high-energy food and antibiotics to treat infection. This allows them to recover at home with their families. They also give guidance on how to treat them for HIV and, if necessary make recommendations on how to treat severely malnourished infants under six months.

“The guidelines are critical because many national health plans currently overlook children with severe acute malnutrition... If these children don’t get the right medical and nutritional care, very often they die,”

Dr Francesco Branca, Director, WHO Department of Nutrition for Health and Development

“The guidelines are critical because many national health plans currently overlook children with severe acute malnutrition. This can be fatal. If these children don’t get the right medical and nutritional care, very often they die,” says Dr Francesco Branca, Director of WHO’s Department of Nutrition for Health and Development.

New guidelines reflect new opportunities and technologies

The new guidelines supersede those issued by WHO in 1999 which recommended that all severely malnourished children be hospitalized, given fortified formula milk and appropriate treatment including antibiotics. The guidelines have been updated to reflect new opportunities and technologies that allow severely malnourished children who have an appetite and no evident medical complications to be effectively treated at home with specially-formulated foods that provide energy and nutrients and antibiotic medicines.

“It’s generally better for children and better for their families if they’re treated as outpatients,” says Dr Elizabeth Mason, Director of WHO’s Department of Maternal, Newborn, Child and Adolescent Health. “It can be easier for families who need to continue providing and caring for other children, and it allows vulnerable, malnourished children to stay home and avoid the risk of getting hospital infections.”

The proactive use of antibiotics is important because the immune system of a child who is severely malnourished can virtually shut down. This lack of immune response means both that the body cannot fight off infection and that tests may not detect infection, even when one is present. Evidence shows that giving a broad spectrum antibiotic such as amoxicillin enables the child’s body to fight off common infections like pneumonia and urinary tract infections which can be fatal to this group of children.

However, the new recommendation is specifically for children with severe acute malnutrition—not those who are simply undernourished. Widespread use of antibiotics among children who do not need them would increase the risk of infections becoming resistant to lifesaving antibiotics—a situation that would harm the health and survival of all children.

Severely malnourished children with HIV

Another new aspect of the guidelines relates to the treatment of severely malnourished children with HIV. The 1999 guidelines did not recommend HIV testing of children with severe acute malnutrition. At that time, there was poor availability and little experience of treating children with antiretroviral drugs. Circumstances today are very different. We now know that antiretrovirals significantly increase survival of children with HIV, and access to these drugs is improving. The new guidelines recommend that children with severe acute malnutrition in countries where HIV is common be routinely tested for the virus, and those who are positive should start on antiretroviral drugs as well as special foods and antibiotics to treat their severe malnutrition.

Infants under 6 months with severe acute malnutrition

The other group whose needs are addressed for the first time in these guidelines are infants under 6 months with severe acute malnutrition. WHO recommends that all babies under 6 months are exclusively breastfed for optimal nutrition and protection against infections. This is particularly important for babies who are severely malnourished. Health services should give special support to mothers of these infants to breastfeed as well as treating the child with antibiotics. If there is no realistic prospect of a severely malnourished baby being breastfed, the family may need breast milk from another woman, e.g. a family member, a neighbour, a wet nurse or a milk bank. If this is not possible, they will need infant formula and support to prepare and use it safely.

For more information please contact:

Fadela Chaib
Communications Officer/Spokesperson
WHO
Telephone: +41 22 791 3228
Mobile: +41 79 475 5556
E-mail: chaibf@who.int

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UK A&Es seeing 'drunk children'

30 September 2013 Last updated at 00:00 ET

Public Health England says one in four underage drinkers consumes more than 15 units a week

Nearly 300 children aged 11 or under were admitted to A&E units across the UK last year after drinking too much, a BBC Radio 5 live investigation shows.

Revealing UK-wide data for the first time, it said a total of 6,500 under-18s were admitted with alcohol-related illnesses in 2012-13.

The data came from 125 of the 189 UK NHS organisations following Freedom of Information requests.

More girls than boys are now being admitted, a reversal of the past trend.

Over the last five years A&E departments across the UK have dealt with nearly 48,000 incidents where under-18s have been admitted for drink or drug related illnesses.

'Hiding away'

Ayrshire and Arran Health Board dealt with the highest number of cases last year - with 483 alcohol-related admissions.

Morten Draegebo, an A&E consultant at Cross House Hospital in Kilmarnock, said children were exposing themselves to significant danger.

He said: "There is a problem with their ability to defend themselves. The typical patient may be found in a field.

"They often need to hide away from any sort of adults in the area so they're picked up by the ambulance service.

"They have difficulty locating where they are because the description comes through from a distressed half-drunk teenager potentially saying that they're under a tree somewhere in a large park.

"Eventually they're found but even in summer-time in Scotland they're vaguely hypothermic.

"They have vomited. The vomit may go down the wrong way into the lungs. They are unable to defend themselves even from assault."

Dr Draegbo added: "We have had many cases where teenage, young teenage females have come in saying that they may have been sexually assaulted and they're that intoxicated and are distressed and say, 'I may have been', but they don't even know if they have been or not.

"On a humane level that is very distressing. I'm a parent, I would hate for that to happen to my daughter."

Heavy burden

There has been a long-term fall in the number of children admitted to A&E after drinking too much - with 2,000 fewer under-18s admitted to A&E last year than in 2009.

Charities and public health bodies agree fewer children are drinking across the UK, but say the amount being consumed has stayed the same - suggesting those who do drink are drinking more.

Public Health England says one in four underage drinkers consumes more than 15 units a week - the equivalent of seven pints of lager.

The official advice from the chief medical officers across the UK is that no children should be given alcohol until they are 16, and alcohol should only be given to older teenagers under supervision of a carer or parent, and never on more than one day a week.

A Department of Health England spokesman said: "We know that fewer young people are drinking and being admitted to hospital as a result.

"But with more than one million alcohol-related hospital admissions overall in the last year we know too many people are drinking too much and that alcohol places a heavy burden on the NHS, costing around ￡3.5bn every year. "

Hear more on the Victoria Derbyshire programme at 10:00 BST on Monday 30 September on BBC Radio 5 Live.

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UN: 6.6 million children under 5 died last year

LAGOS, Nigeria (AP) — Childhood death rates around the world have halved since 1990 but an estimated 6.6 million children under the age of 5 still died last year, the U.N. children's agency said Friday.

Nearly half of all children who die are in five countries: Nigeria, Congo, India, Pakistan and China, it said in a report.

"Progress can and must be made," said Anthony Lake, UNICEF's executive director. "When concerted action, sound strategies, adequate resources and strong political will are harnessed in support of child and maternal survival, dramatic reductions in child mortality aren't just feasible, they are morally imperative."

The top killers are malaria, pneumonia and diarrhea, the report said, taking the lives of about 6,000 children under age 5 daily. A lack of nutrition contributes to almost half of these deaths, the U.N. said.

Eastern and Southern Africa have reduced their death rates for children under 5 by more than 50 percent since 1990. West and Central Africa are the only regions not to have at least halved the number of children under 5 dying over the past 22 years, the U.N. said.

Nigeria bears more than 30 percent of early childhood deaths for malaria and 20 percent of the deaths associated with HIV. Globally, the country accounts for one in every eight child deaths, the U.N. said.

While these numbers are grim, the rate of improvement globally seems to have plateaued at about 4 percent improvement per year since 2005, the report said. The estimated numbers are based on solid data from about half the world's countries. And for regions with the biggest problems, they had to rely on modeling techniques.

Countries like Bangladesh, Ethiopia and Brazil showed tremendous progress, due in part to increased community health care. Affordable and increased interventions — like treated mosquito nets, medicines, rehydration treatments and improved access to safe water — helped improve the early childhood death rate in other countries as well.

But improvements were not as bold in countries like Nigeria, Congo, Sierra Leone and Pakistan, the report showed.

Lake said a new sense of urgency was needed to improve the figures.

"Yes, we should celebrate the progress," he said. "But how can we celebrate when there is so much more to do?"

Copyright c 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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