Child Health

How does human milk banking help ensure child health?

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When a mother is unable to breastfeed, donor milk can make all the difference, especially for small, preterm, and sick infants.

Milk bank Vietnam

At a human milk bank in Vietnam, health workers divide donated milk into bottles for newborns.

The World Health Organization recommends breastfeeding for infants to support healthy growth and development. But why is this recommended? And when women face barriers breastfeeding, what alternatives exist to provide nutrients to newborns?

To answer these questions, let’s learn more about the nutritional value of breastmilk and the benefits of donor milk from human milk banking.

Why is breast milk important to child health?

Superior to formula, human milk provides essential nutrients for infant growth and development. According to UNICEF, “feeding infants nothing but breastmilk guarantees them a food source that is uniquely adapted to their nutrient needs, while also being safe, clean, and healthy.” Despite the nutritional benefits of human milk, less than half of infants under six months old are exclusively breastfed.

Infant mortality remains high globally as millions of babies die within their first year of life. Unfortunately, numerous social, political, and structural barriers can hinder a mother’s ability to breastfeed. These often include the influence of social norms, lack of support for breastfeeding mothers, and impact of infant formula marketing. Additionally, women may lack knowledge about the benefits of breastfeeding or are simply unable to produce enough breastmilk. To help address some of these barriers, PATH is working collaboratively with governments and partners worldwide to increase equitable access to human milk.

What is human milk banking?

Human milk banks play an essential role in newborn health by providing human donor milk to newborns who would otherwise not be able to receive their mothers’ own milk. This is necessary for newborns that are small and/or sick, meaning those that are born preterm, are small for their gestational age, have low birth weight, have an illness or birth complication, as well as those requiring hospitalization. Donor human milk is specifically targeted to this population of newborns.

Donor human milk is used as a bridge, while the mother’s lactation supply can be established and the infant transitions to feeding directly from the breast, equipping both mother and baby for healthy breastfeeding post-discharge. Milk banks collect, screen, store, process, and distribute human milk. Women who donate milk usually breastfeed their own infants and have a milk supply that exceeds their own infants’ needs. Best practice is to implement human milk banks as a component within a comprehensive and integrated system, to ensure they are in line with the broader purpose of protecting, promoting and supporting breastfeeding and child nutrition.

Human milk banks are increasing worldwide, as the global health community recognizes the benefits of such efforts on newborn health. PATH works at a global level advocating for exclusive human milk diets and with Ministries of Health to ensure a sustainable and locally appropriate human milk bank system is embedded within newborn care and breastfeeding promotion—such as our work in Kenya. Furthermore, PATH has resources available for establishing and integrating human milk banks into existing health facilities to expand global access. PATH toolkits detail how to ensure appropriate use of donor human milk and how to introduce a rigorous human milk bank system for screening, pasteurizing, storage and distribution, all of which is required to ensure safe donor human milk. These essential efforts help to provide equitable access to human milk for babies around the world.

Human milk banks help prevent diarrhea

Given what we know about the nutritional benefits of human milk, and the accessibility challenges of this feeding option for newborns, exclusive human milk diets contribute to preventing and reducing diarrheal disease. Infants are at greatest risk of diarrheal disease when they are given foods other than breast milk. This is because they are more likely to be exposed to food- and water-borne pathogens and lose the protection of breast milk’s anti-infective properties. Furthermore, diarrhea is a leading cause of malnutrition in children under five, and malnourished children are more vulnerable to infection. Human milk helps an infant’s immune system to safeguard against infectious diseases like diarrhea and other dangerous pathogens.

Breastfeeding and safe provision of donor human milk are significant in efforts to defeat diarrheal disease­: we encourage stakeholders, health providers, and other advocates to strengthen systems to support exclusive human milk diets and utilize available milk banking resources, when appropriate, to advocate for expanded access to nutritional breastmilk for infants in all regions of the world.

DISTURBING report finds that 20 million American schoolchildren have been prescribed antidepressants

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Image: DISTURBING report finds that 20 million American schoolchildren have been prescribed antidepressants

In many ways the world is a far more complex, difficult place to live in now than it was 20 or 30 years ago. Social media places children under increasing pressure – and at an ever decreasing age – to look perfect, have limitless “friends” and lead apparently perfect lives. Many parents work longer hours than in previous decades, leaving them with little time and energy to spend with their kids. And children are under immense pressure to perform academically and on the sports field.

In previous years, kids could generally be found playing outside with their friends or chatting to them on the phone, but modern society leaves children isolated from one another, spending more time with virtual “friends” than real-life ones. Many spend most of their time online, hardly ever venturing outside.

This toxic mix of external pressures and isolation can leave children, particularly those struggling through adolescence, feeling depressed and confused. The solution for many parents and healthcare professionals is to simply prescribe them antidepressant medications like selective serotonin reuptake inhibitors (SSRIs). This “solution” is so widely favored, in fact, that a disturbing report by the Citizens Commission on Human Rights found that around 20 million American schoolchildren have been prescribed these dangerous drugs.

Antidepressant use in children rises sharply in seven years

Antidepressant medications are, in fact, not recommended for children under the age of 18, but you would never know that if you were to judge by the way doctors hand out prescriptions for these drugs like candy.

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According to the Daily Mail, a study recently published in the European Journal of Neuropsychopharmacology, which studied antidepressant use in children under the age of 18 in five western countries, found that there was an alarming increase in the number of prescriptions for these drugs between 2005 and 2012.

In Denmark, prescriptions for children increased by 60 percent; prescription numbers soared more than 54 percent in the United Kingdom; in Germany, they rose by 49 percent; the United States saw a 26 percent increase; and there was a 17 percent increase in antidepressant prescriptions for children in the Netherlands during that period.

This is shocking because a 2016 study published in the respected British Medical Journal, which evaluated the mental health of 18,500 children prescribed antidepressant medications, found that not only are the benefits of these drugs “below what is clinically relevant” (i.e. they don’t work), but children taking them are twice as likely to exhibit suicidal or aggressive behaviors than children who do not.

The study also found that the drug manufacturers are not only aware of this fact but that they actively try to hide the risks by labeling suicidal thoughts and suicide attempts as “worsening of depression” or “emotional liability” rather than admitting that they are side effects of the medication.

“Despite what you’ve been led to believe, antidepressants have repeatedly been shown in long-term scientific studies to worsen the course of mental illness — to say nothing of the risks of liver damage, bleeding, weight gain, sexual dysfunction, and reduced cognitive function they entail,” warned holistic women’s health psychiatrist, Dr. Kelly Brogan, writing for Green Med Info. “The dirtiest little secret of all is the fact that antidepressants are among the most difficult drugs to taper from, more so than alcohol and opiates.

“While you might call it ‘going through withdrawal,’ we medical professionals have been instructed to call it ‘discontinuation syndrome,’ which can be characterized by fiercely debilitating physical and psychological reactions. Moreover, antidepressants have a well-established history of causing violent side effects, including suicide and homicide. In fact, five of the top 10 most violence-inducing drugs have been found to be antidepressants.”

This doesn’t mean that our children need to be left to struggle through depression and isolation without any help, however. Experts recommend family, individual and other therapies, lifestyle changes including exercise and dietary changes, and spending more time outdoors with family and friends as healthy, side-effect-free ways to help kids cope.

Learn more about the dangers of antidepressant drugs at Psychiatry.news.

Sources include:

GreenMedInfo.com

Independent.co.uk

DailyMail.co.uk

ScienceDaily.com

ADHD and ADD are FAKE disorders stemming from bad schooling practices, HFCS and artificial food coloring

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Image: ADHD and ADD are FAKE disorders stemming from bad schooling practices, HFCS and artificial food coloring

Attention-deficit disorders are defined as brain disorders marked by ongoing patterns of inattention, hyperactivity, and impulsivity, to an extent that it interferes with development and functioning. Symptoms include wandering off task, difficulty sustaining focus, disorganization, defiance, constant movement, fidgeting, tapping, talking, and the inability to delay immediate gratification. Sounds like every adult who’s jacked up on coffee while stuck sitting on a hard chair at some boring work meeting while playing on their smart devices and completely disconnected from the speaker and the content being presented.

Today’s elementary and secondary school curriculum and testing is still based on memorizing rote facts (which are mostly inaccurate), filling in the “blanks,” taking multiple choice quizzes and tests, and raising hands to answer questions posed by the teachers.

Meanwhile, most school breakfasts and lunches (including what most kids bring from home) are chock full of processed foods that contain high fructose corn syrup, artificial coloring, artificial flavoring, concentrated salts, pesticides, and fluoride (think of the water fountains). Children and teens are consuming pop tarts, sugar-laden cereals, soda and energy drinks without knowing the detrimental behavior effects. Plus, kids eat candy throughout the day, some coming from home and the rest from teachers who use genetically modified treats as rewards for “good behavior.” How ironic.

What year did Christopher Columbus arrive in America, and what are the long division steps for dividing 2,437 by 389? Exactly. Who cares.

First off, let’s address what kids are learning in school these days, and how most of the curriculum is cannon fodder, including outdated “skills” and “strategies” that don’t even apply to the real world in any form at all. Unless you’re appearing on the Jeopardy game show, trivia doesn’t matter at all. As for long division, nobody needs to know that dead dinosaur at all. We have computers, smart devices and even watches with calculators now.

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Kids don’t engage learning unless they’re engaged in collaboration, creativity, communication, critical thinking, and citizenship (The 5 C’s of 21st century learning).

Rote memory learning drives any human being crazy. Children are brilliant, and no curriculum in the world that’s based on rote memorization, boring worksheets, and taking multiple choice tests will ever keep them quiet, still, and “paying attention” for more than a couple minutes. Students want to know the answers to their questions like, “What does this have to do with the real world?” and “How does this help us get smarter?”

https://www.real.video/embed/5834171584001

Every single “symptom” of ADHD and ADD is a symptom of poorly planned educational systems, lack of real world connections, and bad diet

In the DSM-IV (The American Psychiatric Association manual and the pages describing diagnostic criteria for Attention Deficit Disorders), any children who can’t pay attention for extended periods of time, who don’t complete their homework, or who are often distracted by “extraneous stimuli” are in need of prescription psyche medications. According to DSM-IV, “symptoms must be present for at least 6 months …” and required to cause “some impairment in at least two settings” for a diagnosis of a brain disorder to be applied. The DSM-V is even worse, and offers no clear guidelines. Well, did the DSM-IV offer any “clear” guidelines? What’s clear is that psychiatrists can now diagnose ANY child or adolescent anytime with ADD or ADHD.

What’s clear is that students need real world education instead of memorizing facts for tests that they completely forget three days later. What’s clear is that science proves that artificial food colorings, soda, and high fructose corn syrup cause severe hypersensitivity reactions, affect behavior, reduce cognition, deplete the retention of information, and cause mental distress. Where’s all that information in the DSM manuals?

15 Million pounds of artificial dyes are put in U.S. foods, drinks, candy, and medicine every year

There has been a 55 percent increase in U.S. toxic food dyes just since the year 2000. There are over 15 million pounds of dyes put in foods, drinks, candy and medicine every year, and the FDA does nothing to protect consumers from the barrage of poison.

Did you know that the industrial-based food dye Yellow #5 affects behavior and induces severe hypersensitivity reactions? Fact: Teenagers who drink more than one large soda (4 glasses) per day experience mental health difficulties, including hyperactivity and mental distress, according to a study recently published in the American Journal of Public Health. Those same soda drinkers also score lower on tests, per the scientific research conducted.

In conclusion, if your child is “suffering” from ADD or ADHD symptoms, before you rush to a medical quack for SSRI drugs that cause severe depression, suicides, and homicidal tendencies, change your child’s diet to organic foods (stop buying school meals all together), and talk to the school’s principals and administrators about engaging the students with some real world curriculum.

Sources for this article include:

HelpforADD.com

NIMH.nih.gov

TotallyADD.com

NaturalNews.com

NaturalNews.com

NCBI.nlm.nih.gov

Food.news

Daytime naps ‘can boost learning’

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Getting young children to take an hour-long nap after lunch could help them with their learning by boosting brain power, a small study suggests.

A nap appeared to help three-to-five-year-olds better remember pre-school lessons, US researchers said.

University of Massachusetts Amherst researchers studied 40 youngsters and report their findings in Proceedings of the National Academy of Sciences.

The benefit persisted in the afternoon after a nap and into the next day.

The study authors say their results suggest naps are critical for memory consolidation and early learning.

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“Start Quote

This is important, because pre-school nurseries are divided on whether they should allow their children a nap”

Paediatrician Dr Robert Scott-Jupp

When the children were allowed a siesta after lunch they performed significantly better on a visual-spatial tasks in the afternoon and the next day than when they were denied a midday snooze.

Following a nap, children recalled 10% more of the information they were being tested on than they did when they had been kept awake.

Close monitoring of 14 additional youngsters who came to the researchers’ sleep lab revealed the processes at work in the brain during asleep.

As the children napped, they experienced increased activity in brain regions linked with learning and integrating new information.

Memory aid

Lead investigator Rebecca Spencer said: “Essentially we are the first to report evidence that naps are important for preschool children.

“Our study shows that naps help the kids better remember what they are learning in preschool.”

She said while older children would naturally drop their daytime sleep, younger children should be encouraged to nap.

Dr Robert Scott-Jupp, of the Royal College of Paediatrics and Child Health, said: “It’s been known for years that having a short sleep can improve the mental performance of adults, for example doctors working night shifts. Up until now, no-one has looked at the same thing in toddlers. This is important, because pre-school nurseries are divided on whether they should allow their children a nap.

“Toddlers soak up a huge amount of information everyday as they become increasingly inquisitive about the world around them and begin to gain independence.

“To be at their most alert toddlers need about 11-13 hours of sleep a day, giving their active minds a chance to wind down and re-charge, ready for the day ahead. We now know that a daytime sleep could be as important as a nighttime one. Without it, they would be tired, grumpy, forgetful and would struggle to concentrate.”

9 Secrets of Highly Happy Children.

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Story at-a-glance

  • Stress, depression and poor mood impact kids just like adults, so tending to your child’s emotional health is vitally important
  • Healthy eating, proper sleep, and time for free play are essential for kids’ happiness
  • Kids also need unconditional love, the ability to make choices and express their emotions, and they need to feel heard by their parents
  • You have a tremendous impact on your child’s happiness; lead by example by modeling happy, healthy habits for your children

Children are probably not the first ones who come to mind when you think about stress. After all, they’ve got no bills to worry about, no job or other responsibilities on their shoulders…

healthy-eating

Yet, children feel stress, too – often significantly. They worry about making friends, succeeding at school or sports, and fitting in with their peers. They may also struggle with the divorce of their parents or feel anxious about war and violence they see on the news.

While a child’s natural state is to be happy, vibrant and curious, it’s estimated that up to 15 percent of children and teens are depressed at any given time.1

In reality, many of the same worries that make you feel anxious and sad have the same impact on your children. However, kids also have unique needs that can interfere with their ability to be happy if left unmet.

Nine Tips for Raising a Happy Child

Virtually every parent wants their child to be happy. The Huffington Postrecently highlighted seven simple strategies for achieving this goal,2 and I’ve added a couple of my own as well.

1. Healthy Eating

Mood swings and even depression in kids are often the result of a heavily processed-food diet. In fact, the greatest concentration of serotonin, which is involved in mood control, depression and aggression, is found in your intestines, not your brain! Your gut and brain actually work in tandem, each influencing the other.

This is why your child’s intestinal health can have such a profound influence on his mental health, and vice versa – and why eating processed foods that can harm his gut flora can have a profoundly negative impact on his mood, psychological health and behavior.

The simplest way back toward health and happiness, for children and adults alike, is to focus on WHOLE foods — foods that have not been processed or altered from their original state; food that has been grown or raised as nature intended, without the use of chemical additives, pesticides and fertilizers.

You, a family member, or someone you pay will need to invest time in the kitchen cooking fresh wholesome meals from these whole foods so that you can break free from the processed food diet that will ultimately make you and your children sick.

Food is a part of crucial lifestyle choices first learned at home, so you need to educate yourself about proper nutrition and the dangers of junk food and processed foods in order to change the food culture of your entire family. 

To give your child the best start at life, and help instill healthy habits that will last a lifetime, you must lead by example. If you’re not sure where to start, I recommend reading my nutrition plan first. This will provide you with the foundation you need to start making healthy food choices for your family.

2. Eating on Time

If a child goes too long without eating, it may lead to fluctuations in blood sugar levels that lead to irritability. Children need to refuel their growing bodies on a regular schedule, so try to keep your child’s meal and snack times consistent.

3. Regular, High-Quality Sleep

Too little sleep not only makes kids prone to being grouchy and having mood swings, it also negatively impacts children’s behavior and attention. In fact, as little as 27 minutes of extra sleep a night has been shown to have a positive impact on children’s mood and behavior.3

Children aged 5 to 12 need about 10-11 hours of sleep a night for optimal mood and health. To help your child get a good night’s sleep, get the TV, computer, video games and cell phone out of your child’s bedroom, and be sure the room is as dark as possible. Even the least bit of light in the room can disrupt your child’s internal clock and her pineal gland’s production of melatonin and serotonin. I recommend using blackout shades or drapes. For my complete recommendations and guidelines that can help you improve your child’s sleep, please see my article 33 Secrets to a Good Night’s Sleep.

4. Free Play

Unstructured playtime is essential for kids to build their imagination, relieve stress and simply be kids. Yet today, many kids are so over-scheduled that they scarcely have time to eat dinner and do homework, let alone have any free time for play. Even the American Academy of Pediatrics states that free, unstructured play is essential for children to manage stress and become resilient, as well as reach social, emotional and cognitive development milestones.4

Along with slowing down and resisting the urge to sign your child up for too many activities, be sure to provide your child with simple toys like blocks and dolls that allow for creative play. Free play time is also an ideal time for active play – like tag or chasing butterflies – which is naturally mood-boosting (as exercise is for adults).

5. Express Emotions

Kids need to yell, cry, stomp their feet and run around with excitement. This is how they express their emotions, which is healthy for emotional development and will prevent a lifetime of internalizing negative emotions. Encourage and allow your child to vent and express his emotions in healthy ways.

6. Make Choices

Kids are constantly being told what to do, so giving them the ability to make choices goes a long way toward increasing their happiness. Try letting your child decide what to wear or what to eat (within reason), or give her a few choices for activities and let her decide which one to do.

7. They Feel Heard

Your child knows when you’re not really listening to them (such as if you’re ‘talking’ to them while surfing the Web or watching TV). Yet a child’s happiness will soar when he feels like his parents truly listen and respond to what he’s saying. Not only will you feel more connected to your child, but you’ll also build his self-confidence and happiness.

8. Unconditional Love

Above all else, children need unconditional love, and they need it consistently. If your child makes a mistake, let her know you still love and support her regardless. Your child will grow up confident and happy knowing you are behind her every step of the way.

9. Be Happy Yourself

If you’re stressed out and unhappy, your child will sense this and also feel sad and worried in response. You are your child’s first role model, so lead by example by embracing the bright side of life. If you need some help, use these 22 positive habits of happy people to become a happy person yourself.

Does Your Child’s Mood Need an Extra Boost?

If you’ve addressed the lifestyle factors listed above, especially proper diet, sleep and time for free, unstructured play, but your child is still unhappy (for no obvious reason, such as being bullied or due to stress such as divorce at home), try these three tips below:

·         High-quality animal-based omega-3 fats: Low concentrations of the omega-3 fats EPA and DHA are known to increase your risk for mood swings and mood disorders. Those suffering from depression have been found to have lower levels of omega-3 in their blood, compared to non-depressed individuals. Krill oil is my preferred source of omega-3 fats.

·         Regular sun exposure: This is essential for vitamin D production, low levels of which are linked to depression. But even beyond vitamin D, regular safe sun exposure is known to enhance mood and energy through the release of endorphins.

·         Emotional Freedom Technique (EFT): If difficult life circumstances and the negative emotions they create are making happiness hard to come by for your child, try EFT, which is a form of do-it-yourself psychological acupressure. This simple technique can help clear your body and mind of negative emotions so you can implement positive goals and habits more easily in your life, and kids can learn to do it themselves.

·         Source: mercola.com

 

 

Management of infantile colic.

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Abstract

Although infantile colic is considered to be a self-limiting and benign condition, it is often a frustrating problem for parents and caregivers. It is a frequent source of consultation with healthcare professionals and is associated with high levels of parental stress and anxiety.1,2Several published reviews of the literature have explored dietary, pharmacological, complementary and behavioural therapies as options for the management of infantile colic.1,3 Here, we assess whether these management options are supported by the literature and if there are any novel treatment options.

About infantile colic

Infantile colic has been defined as paroxysmal uncontrollable crying in an otherwise healthy infant less than 3 months of age, with more than 3 hours of crying per day, in more than 3 days a week and for more than 3 weeks.4,5 It is known to have a significant impact on infants and their families, with up to one in six families with children with symptoms of colic consulting healthcare professionals.6

Background

Despite the prevalence of the condition, the pathogenesis remains incompletely understood. One hypothesis has suggested that infantile colic is caused by the impact of abnormal gastrointestinal motility and pain signals from sensitised pathways in the gut viscera.2 Another hypothesis is that inadequate amounts of lactobacilli and increased amounts of coliform bacteria in the intestinal microbiota influences gut motor function and gas production, which subsequently contributes to the condition.2

More controversially, behavioural issues such as family tension, parental anxiety or inadequate parent-infant interaction have also been explored as causative factors for infantile colic.1 In addition, little is known about concomitant risk factors; however, maternal smoking, increased maternal age and firstborn status are thought to be associated with the development of infantile colic. No association with feeding method has been noted.1

As a consequence of the lack of understanding of the cause of the condition, a wide spectrum of treatment modalities have been suggested, with each one targeted to address a postulated cause.

Diagnosis

Although infantile colic is by definition a benign condition, healthcare professionals should address parental concerns carefully, as the diagnosis is made by exclusion of more sinister causes.

Management options

There are numerous issues with the methodological rigour of many intervention studies with several systematic reviews on infantile colic describing shortcomings in trial methodology. Whilst some form of randomisation was performed with many of these studies, lack of a clear definition for infantile colic, absence of clinically meaningful  end-points (aside from crying duration), and limited detail on sample size calculations, allocation concealment and randomisation methods are likely to have affected the validity of the results. It is therefore appropriate to take a cautious approach in translating the outcomes of research to practical recommendations for managing infantile colic.

Diet modification

Based on the theory that infantile colic results from excessive gas production from poor gut digestion of cow’s milk proteins, several nutritional interventions have been reviewed.2

In practice, any positive impact of diet modification may result from improving symptoms of colic secondary to a previously undiagnosed cow’s milk protein allergy in the infant. Therefore, it is important that cow’s milk protein allergy is considered during the assessment of an infant with inconsolable crying. There are currently no reported unwanted effects for any of the diet modification studies described below.9

Hypoallergenic formula preparations for bottle-fed infants

In hydrolysed formulae, whole milk proteins are broken down to prepare them for digestion. These can range from partially hydrolysed to completely hydrolysed formula preparations with the former often used for lactose intolerance and the latter used in the management of cow’s milk protein allergy.9

Several systematic reviews have identified studies that demonstrated that completely hydrolysed formulae significantly improved clinical symptoms of infantile colic, such as crying time.1,9,10 These studies used standard cow’s milk formula as the comparator and improvements were noted from 7 days onwards. When carbohydrate and fat content compositions were varied in one study, both proved similarly effective in reducing colic symptoms, suggesting that changes to carbohydrate and fat content had no effect.9

In one systematic review, two randomised controlled trials (RCTs) noted that partially hydrolysed formulae reduced colic symptoms after 14 days of feeding. However, the trials did not involve a direct comparison with a regular cow’s milk formula, but compared partially hydrolysed formulae and soy-based formulae.9

Where a suspicion of cow’s milk protein allergy exists there is some evidence that the use of an empirical time limited trial of a completely hydrolysed formula is a reasonable option.1,9,10Correspondingly, whilst there is some literature advocating the use of partially hydrolysed formula,9 its use for the dietary management of colic would not be recommended because partially hydrolysed formulae are not hypoallergenic and therefore will not address colic symptoms secondary to a protein allergy.10

High-fibre formula

High fibre or fibre-enriched formulas are those that are fortified with typically a soy polysaccharide to increase the dietary fibre concentration. An RCT identified by two systematic reviews found no significant difference in symptoms when comparing a high-fibre formula with a standard formula.1,9

Soy-based formula

Two systematic reviews noted several low quality studies that demonstrated a reduction in crying duration when comparing soy-based formula with standard cow’s milk formula after 7 days of feeding.9,10 However, due to concerns about the levels of phytoestrogens in soy-based formula and that soy protein may be an allergen in infancy, its use in infantile colic is not recommended.10,11

Hypoallergenic maternal diet for breast-fed infants

A hypoallergenic diet for breast feeding mothers excludes cow’s milk products and other possible trigger foods. In comparison to the use of a hypoallergenic infant formula, there is limited evidence supporting the use of hypoallergenic maternal diet, with several studies noting equivocal results.1,9,10 This has been attributed to the use of an incompletely hydrolysed diet without a thorough exclusion of trigger foods that could have reduced the effect of the intervention.9

One systematic review, identified a good quality RCT in which mothers eliminated dairy foods, eggs, peanuts, tree nuts, wheat, soy and fish from their diet.9 The primary endpoint of the study was a reduction in cry/fuss duration of >25% from baseline with more responders in the low-allergen diet group compared with the control group, 74% vs. 37%, an absolute risk reduction of 37% (95%CI 18% to 56%).10 Two earlier studies reported similar findings but neither separated the results for breastfed infants from hypoallergenic formula fed infants.9

On balance there is limited evidence to suggest that hypoallergenic diets in mothers may be helpful. If a time limited trial is undertaken, mothers should be advised to exclude trigger foods including cow’s milk products from their diet and to ensure that they and their infant receive appropriate nutritional support, including calcium and vitamin D intake. They should also be advised not to discontinue breastfeeding while switching to the hypoallergenic maternal diet.1,9,10

Lactase therapy

In lactase therapy, galactosidase (lactase) drops are mixed with breast or bottle milk feeds up to 24 hours prior to feeding the infant. A systematic review identified two RCTs where an improvement in symptoms was noted with the use of lactase therapy. In one RCT, a relative decrease in crying time of 22.4% (95% CI 13% to 44%) was noted.1 This conflicted with several other RCTs noting no improvement with the use of lactase in either breast or formula milk. In one example, only a 40-minute reduction in crying time was observed compared with placebo.1

Pharmacological management

It is hypothesised that the gut’s peristaltic cholinergic activity is linked to gastrointestinal discomfort in infantile colic. Consequently, anticholinergics, such as dicyclomine hydrochloride and cimetopium bromide, which reduce smooth muscle activity, have been studied. Neither of these drugs are licensed in the UK for use in infants.

In one systematic review, two studies investigating dicyclomine hydrochloride noted improvement in colic symptoms. However, severe adverse effects including respiratory distress and seizures led to its licence withdrawal in infants less than 6 months of age.7 One study has reported significant improvements with the use of cimetropium bromide with only drowsiness noted as a side effect.1,3–7

Simethicone (Infacol®), which reduces intraluminal gas and is readily available over the counter, has been studied in two RCTs. No difference in reducing colic episodes was shown compared with placebo.1,7

Complementary therapies and other interventions

In the absence of safe and effective pharmacological interventions, complementary therapies have taken a more prominent role in the management of infantile colic. These can range from conventional therapies, such as dietary supplements, sugar solutions, herbal extracts or massage, to controversial options such as chiropractic treatment.

Herbal supplements

A systematic review identified several studies of herbal supplements, such as fennel extract and mixed herbal tea that showed a reduction in symptoms of infantile colic.12 However, several adverse effects such as vomiting, sleepiness, constipation and loss of appetite were also noted.12 Minimal information on extraction and preparation of herbs and lack of standardisation of dosage and formulations have also limited their use.2

Sucrose solutions

Two studies compared glucose solutions with placebo and found positive effects in relieving symptoms.2 However, there are concerns about potential nutritional effects, in particular the content of sugar and alcohol, the lack of formulation standardisation and the poor quality of the evidence.2,12,13

Probiotics

Based on the hypothesis that aberrant intestinal microflora affecting gut function and gas production may contribute to the condition, the use of probiotics in infantile colic has become more common. Numerous studies have been identified in a systematic review.12,14,15 One randomised double blind placebo controlled trial involving 46 infants used a suspension of freeze-dried Lactobacillus reuteri. There were significantly more responders (50% reduction in crying time from baseline) in the L reuteri group on days 7 (20 vs. 8; p = 0.006), 14 (24 vs. 13; p = 0.007), and 21 (24 vs. 15; p = 0.036). A further RCT identified good weight gain and gastrointestinal tolerance.2

Massage

One study noted a positive effect in massage utilising aromatherapy oils. However, the results were not separated between massage and aromatherapy.16 Whilst several other studies identified in a systematic review12,13 showed some improvement on symptoms of colic, overall the quality of these studies is poor.

Swaddling

Swaddling has traditionally been used by some parents to reduce crying in infancy. A systematic review noted that swaddling reduced crying symptoms compared with massage in excessively crying infants with cerebral damage.17 However, there is a known associated risk of developing hip dysplasia, overheating or sudden infant death syndrome if placed in the prone position. The current evidence base, therefore, does not support the use of swaddling in the management of infantile colic.

Chiropractic treatment

As a more controversial complementary therapy, chiropractic care is sometimes advocated as a treatment option for infantile colic. Chiropractic care can include, but is not limited to, cranial osteopathy and spinal manipulation therapy. The evaluation of treatment options in this field is challenging due to the absence of good quality RCTs. Additionally, adverse effects such as vertebral artery dissection have been reported anecdotally.18,19

It is hypothesised that chiropractic care can have a positive effect on symptoms; however, the literature has noted that this may be a consequence of improving parents’ coping ability with the condition rather than true effectiveness of chiropractic care.20

In several systematic reviews, one single blinded RCT was identified noting no differences in outcomes between chiropractic care and placebo, which was infant holding by a nurse.21Several other studies were identified noting positive treatment effects; however, these were noted to be of low quality.12,18,19,21,22

Acupuncture

Several RCTs evaluating acupuncture were identified, of which two RCTs noted a shorter duration and intensity of infantile colic symptoms.23,24 Another good quality double blinded RCT comparing acupuncture with a sham needle insertion noted no major effect on symptoms including feeding, bowel movement frequency and sleep.25

Behaviour modification

Several behavioural interventions were identified, that aimed to provide reassurance to parents and offer alternative methods to treat colic.3

One systematic review identified two controlled trials where the use of modified parent and infant interaction led to significant reduction in colic symptoms and additional benefits of early gains in development.1,26 This has been attributed to increased maternal responsiveness and time spent with infants resulting in increased infant alertness. In another study, entire family involvement utilising an integrated care model led to the relief of infantile colic symptoms more readily than standard care.27 The use of ‘contingent music’ was noted to decrease symptoms in another study.1

It has been noted that the identification of effective coping strategies and counselling methods to assist parents in managing this stressful condition is imperative.28 A systematic review identified two studies addressing this; one study utilised a home based nursing intervention and another utilised counselling on specific management techniques and car ride simulation in infants over 6 weeks of age, leading to significant reductions in parental stress and anxiety.1,3

Guidelines

The National Institute for Health and Clinical Excellence guideline on postnatal care advises that holding the baby through the crying episode, and accessing peer support may be helpful, and that the use of hypoallergenic formula in bottle-fed babies should be considered for treating colic, but only under medical guidance.29

A position statement by the Canadian Paediatric Society on dietary interventions commented that a minority of infants have symptoms of infantile colic secondary to cow’s milk protein allergy, and in such cases a maternal hypoallergenic diet for breastfed infants and an extensively hydrolysed formula for bottle fed infants may help.10 In addition, it concluded that there is no proven role for the use of soy-based formulas or lactase therapy and insufficient data to make a recommendation on the effect of probiotics.

The Clinical Knowledge Summary (CKS) noted that “although there are many studies of interventions for infantile colic, most are of poor methodological quality”.30 The guidance suggests that clinicians should “only consider trying medical treatments if parents feel unable to cope despite advice and reassurance”. Options listed include a 1-week trial of simeticone drops (breastfed or bottle-fed infants); a 1-week trial of diet modification to exclude cow’s milk protein (dairy-free diet for the mother [breast-fed infants], hypoallergenic formula [bottle-fed infants]); a 1-week trial of lactase drops (breastfed or bottle-fed infants). However, it should be noted that the CKS guidance was last revised in 2007. A Map of Medicine healthguide on infantile colic also cites the CKS guidance.31

Other issues

There is evidence of inconsistent advice relating to early infant crying and colic in various media outlets such as parenting magazines.32 Advice was noted to be “diffuse, varied, and generally unrelated to the current evidence-based conceptualization of early infant crying”.

Advice for community pharmacists has summarised many of the options available over the counter (including those for which there is little evidence of efficacy e.g. gripe water) and highlighted resources and support groups.33

Conclusion

Parents with infants with colic commonly consult a healthcare professional. Each case should be thoroughly assessed because of the wide range of other conditions that can present in a similar way. For the majority of cases simple reassurance is all that is required. If the clinician feels intervention is required, there are a wide range of options available with a poor evidence base to support any of them.

Currently, there are no effective and safe pharmacological management options available over the counter or by prescription. Simeticone, lactase drops and probiotics are unlikely to be harmful, but there is little evidence to support their use. Whilst complementary treatment options exist there is currently insufficient evidence to recommend their use. The absence of strong evidence is similarly noted for behavioural modification interventions. Despite this, the absence of side effects makes the argument for a trial of such an intervention more compelling.

Where there is a suspicion of cow’s milk protein allergy, a short trial of hypoallergenic feeding, through a hypoallergenic formula in bottle-fed infants may be considered. The improvement in infants with this approach may in part be as a result of treatment of undiagnosed cow’s milk allergy rather than symptomatic improvement of colic. In breastfeeding mothers there is limited evidence that a fully hypoallergenic exclusion diet may be helpful if undertaken carefully.

Infantile colic, whilst self-limiting and benign, can cause considerable distress to parents and it is therefore important that parental support is provided. Advice and guidance on where to obtain support outside conventional healthcare sources should be discussed with parents.

Source: BJM

‘Steep decline’ in child epilepsy.

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  • _65657552_m1500275-brain_and_brain_waves_in_epilepsy-splThe number of children being diagnosed with epilepsy has dropped dramatically in the UK over the past decade, figures show.

A study of GP-recorded diagnoses show the incidence has fallen by as much as half.

Researchers said fewer children were being misdiagnosed, but there had also been a real decrease in some causes of the condition.

Other European countries and the US had reported similar declines, they added.

Epilepsy is caused when the brain’s normal electrical activity result in seizures.

Data from more than 344,000 children showed that the annual incidence of epilepsy has fallen by 4-9% year on year between 1994 and 2008.

Overall the number of children born between 2003-2005 with epilepsy was 33% lower then those born in 1994-96.

When researchers looked in more detail and included a wider range of possible indicators of an epilepsy diagnosis the incidence dropped by 47%.

Correct diagnosis

Better use of specialist services and increased caution over diagnosing the condition explains some, but not all, of the decline in the condition, the researchers reported in Archives of Diseases in Childhood.

Introduction of vaccines against meningitis and a drop in the number of children with traumatic brain injuries, both of which can cause epilepsy, has probably also contributed to falling cases, they added.

Epilepsy remains one of the most prevalent neurological conditions in children in the UK”

Study author Prof Ruth Gilbert, director of the Centre for Evidence-based Child Health at University College London, said: “The drop is consistent with what has been seen in other countries so it is reassuring that we are seeing the same pattern.

“We’re getting better at diagnosing and deciding who should be treated and then there is also probably an effect of factors like fewer cases of meningitis.”

She said in the past, there was an issue with variable diagnosis and some children being treated who did not need to be.

“There is a more rigorous approach and that is partly down to NICE guidance.

“It is very troubling to have a misdiagnosis because once you have a diagnosis it sticks and that does blight the life of a child.”

Simon Wigglesworth, deputy chief executive at Epilepsy Action, said: “It may indicate a reduction in misdiagnosis rates in children, which we know to be high. However, our discussions with leading clinicians suggest that this may not be the complete picture.

“They tell us that they are not seeing a reduction in the number of children with epilepsy presenting at their clinics and epilepsy remains one of the most prevalent neurological conditions in children in the UK.”

Source: BBC