Winston-Salem, U.S.A. – With nearly one-third of American children being overweight or obese, doctors agree that there is an acute need for more effective treatments. In many weight management programs, the dropout rate can be as high as 73%, and even in successful programs, the benefits are usually short term.

Although family-based approaches to pediatric obesity are considered the gold standard of treatment, theories of the family and how it functions have not been incorporated into effective interventions, according to a study published in the May issue of the International Journal of Obesity by researchers at Wake Forest Baptist Medical Center.

“The field of family studies provides an innovative approach to the difficult problem of pediatric obesity, building on the long-established approach of family-based treatment,” said Joseph Skelton, M.D., assistant professor of pediatrics and director of the Brenner FIT (Families in Training) Program at Wake Forest Baptist, and lead author of the study.

Skelton and his research team reviewed medical literature published between 1990 and 2011 to identify the use of prominent family theories in pediatric obesity research. Of the 76 manuscripts found, 13 were selected for the study.

Wake Forest Baptist researchers found limited use of family theories in the study of pediatric obesity, particularly in weight management treatments. Family behavioral theories can provide valuable insight into the complexities of families, and increased use of these theories in both research and practice may help in the development of more effective treatments for childhood obesity, the study found.

“Traditionally doctors looked at the patient as the one in the family to focus on, but now we have to look at the entire family as the patient,” Skelton said.

“One of the problems we found was that there wasn’t even a clear definition of family in the literature. A two-parent household with a stay-at-home mother and working father is no longer the norm. Inability to define the family makes it difficult to apply a straightforward model of family function to child health and weight management.”

In the clinic setting, families are often represented by a child and a parent, typically the mother. However, this often does not accurately reflect family complexity and it doesn’t define which family members should be included in treatment, Skelton said.

A common theme in the field of family studies is that families are a system, made up of interdependent units. Intervening with one unit, such as a mother and a child, will influence other units. These interpersonal relationships influence the health behaviors of the child and the family as a whole, according to the study.

“The challenge is to find ways to incorporate the entire family in the process, while allowing for different schedules and different age kids with different health needs,” Skelton said. “If we don’t find more effective treatments and this epidemic continues, these children will likely go on to become obese adults, resulting in an entire generation with lower life expectancies than their parents’ generation.”

Skelton and his team at Brenner FIT have begun incorporating theories of the family into their research and in their treatment approach, and are finding ways to engage more members of the family in treatment.

Funding for the study was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Duke Endowment and the Kate B. Reynolds Charitable Foundation.

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A study of more than 11,000 children followed for over six years has found that young children with sleep-disordered breathing are prone to developing behavioral difficulties such as hyperactivity and aggressiveness, as well as emotional symptoms and difficulty with peer relationships, according to researchers at Albert Einstein College of Medicine of Yeshiva University. Their study, the largest and most comprehensive of its kind, published online in the journal Pediatrics on March 5.

“This is the strongest evidence to date that snoring, mouth breathing, and apnea [abnormally long pauses in breathing during sleep] can have serious behavioral and social-emotional consequences for children,” said study leader Karen Bonuck, Ph.D., professor of family and social medicine and of obstetrics & gynecology and women’s health at Einstein. “Parents and pediatricians alike should be paying closer attention to sleep-disordered breathing in young children, perhaps as early as the first year of life.”

Sleep-disordered breathing (SDB) is a general term for breathing difficulties that occur during sleep. Its hallmarks are snoring (which is usually accompanied by mouth breathing) and sleep apnea. SDB reportedly peaks from two to six years of age, but also occurs in younger children. About 1 in 10 children snore regularly and 2 to 4 percent have sleep apnea, according to the American Academy of Otolaryngology–Health and Neck Surgery (AAO-HNS). Common causes of SDB are enlarged tonsils or adenoids.

“Until now, we really didn’t have strong evidence that SDB actually preceded problematic behavior such as hyperactivity,” said Ronald D. Chervin, M.D., M.S., a co-author of the study and professor of sleep medicine and of neurology at the University of Michigan.

“Previous studies suggesting a possible connection between SDB symptoms and subsequent behavioral problems weren’t definitive, since they included only small numbers of patients, short follow-ups of a single SDB symptom, or limited control of variables such as low birth weight that could skew the results. But this study shows clearly that SDB symptoms do precede behavioral problems and strongly suggests that SDB symptoms are causing those problems.”

The new study analyzed the combined effects of snoring, apnea and mouth-breathing patterns on the behavior of children enrolled in the Avon Longitudinal Study of Parents and Children, a project based in the United Kingdom.

Parents were asked to fill out questionnaires about their children’s SDB symptoms at various intervals, from 6 to 69 months of age. (Studies of similar questionnaires have shown that parents do a good job of assessing kids’ SDB: their evaluations compare well with data from carefully controlled overnight sleep studies, Dr. Bonuck reports.)

When their children were approximately four and seven years old, parents filled out the Strengths and Difficulties Questionnaire (SDQ), which is widely used to assess behavior.

The SDQ has scales for assessing a child’s inattention/hyperactivity, emotional symptoms (anxiety and depression), peer problems, conduct problems (aggressiveness and rule-breaking), and prosocial behavior (sharing, helpfulness, etc.). The researchers controlled for 15 potential confounding variables, including socioeconomic status, maternal smoking during the first trimester of pregnancy, and low birthweight.

“We found that children with sleep-disordered breathing were from 40 to 100 percent more likely to develop neurobehavioral problems by age 7, compared with children without breathing problems,” said Dr. Bonuck.  “The biggest increase was in hyperactivity, but we saw significant increases across all five behavioral measures.”

Children whose symptoms peaked early—at 6 or 18 months—were 40 percent and 50 percent more likely, respectively, to experience behavioral problems at age 7 compared with normally-breathing children. Children with the most serious behavioral problems were those with SDB symptoms that persisted throughout the evaluation period and became most severe at 30 months.

Researchers believe that SDB could cause behavioral problems by affecting the brain in several ways: decreasing oxygen levels and increasing carbon dioxide levels in the prefrontal cortex; interrupting the restorative processes of sleep; and disrupting the balance of various cellular and chemical systems.

Behavioral problems resulting from these adverse effects on the brain include impairments in executive functioning (i.e., being able to to pay attention, plan ahead, and organize), the ability to suppress behavior, and the ability to self-regulate emotion and arousal.

“Although snoring and apnea are relatively common in children, pediatricians and family physicians do not routinely check for sleep-disordered breathing,” said Dr. Bonuck. “In many cases, the doctor will simply ask parents, ‘How is your child sleeping?’ Instead, physicians need to specifically ask parents whether their children are experiencing one or more of the symptoms—snoring, mouth breathing or apnea—of SDB.”

“As for parents,” said Dr. Bonuck, “if they suspect that their child is showing symptoms of SDB, they should ask their pediatrician or family physician if their child needs to be evaluated by an otolaryngologist (ear, nose and throat physician) or sleep specialist.”

According to the AAO-HNS, surgery is the first-line treatment for severe pediatric SDB in cases where the tonsils and adenoids are enlarged. Another option is weight loss for overweight or obese children.

Dr. Bonuck’s paper is titled “Sleep Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years.” In addition to Dr. Bonuck, other Einstein contributors were Katherine Freeman, Dr.P.H., and Linzhi Xu, Ph.D. The study was supported by grants from the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.

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Childhood obesity has been a rising problem for some time now, and most Americans are aware of the epidemic proportions that childhood obesity has reached. According to a new CNN report, however, this children’s health crisis is presenting whole new sets of challenges. CNN reveals that many children are outgrowing their clothing, and even the furniture used in their schools. According to Children of America CEO Thad Pryor, the CNN report points to a serious problem — and a possible solution.

In his time as the leader of Children of America, Thad Pryor has championed the cause of children’s fitness. One of his most noteworthy initiatives has been the implementation of a Presidential Fitness program, in Children of America locations across the country. According to Thad Pryor, the CNN study goes a long way toward illustrating why childhood obesity is such an urgent concern.

In fact, Thad Pryor points to one anecdote as particularly troubling. The CNN story reports that a 14-year-old boy, having reached a weight of more than 300 pounds, found himself no longer able to fit comfortably in his school desk. Rather than ask for the school to accommodate his physical need, however, the student suffered quietly, simply not wishing to draw attention to himself.

According to Thad Pryor, this public school incident reveals how bad the problem of childhood obesity has become, but it also reminds us of where a possible solution lies — in education. According to the Children of America CEO, teaching kids to make healthy choices from a young age might be one of the best ways to prevent obesity later in life. His own fitness initiatives at Children of America serve as a possible model.

Thad Pryor, a former martial arts champion, has emphasized the importance of physical fitness throughout his time at Children of America. He notes that physical development goes hand in hand with mental development, and that an emphasis on strong body-and-mind connection ultimately helps kids do better in their academic pursuits.

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Children who don’t conform to expected gender stereotypes, even before age 11, are at significantly greater risk for physical, sexual and psychological abuse during childhood and symptoms of post-traumatic stress disorder (PTSD) in young adulthood, report researchers at Children’s Hospital Boston. Their findings, based on a large, national, population-based sample, appear in the March 2012 Pediatrics (published online February 20).

The NIH-funded study, led by S. Bryn Austin, ScD, of Children’s Hospital Boston and the Harvard School of Public Health, used data gathered by questionnaire from almost 9,000 young adults (average age, 23) who enrolled in the longitudinal Growing Up Today Study in 1996.

In 2007, respondents were asked to recall their childhood experiences, including favorite toys and games, roles they took in pretend play, media characters they imitated or admired, and feelings of femininity or masculinity. They were also asked about physical, sexual or emotional abuse they experienced at the hands of parents, other adults or older children, and were screened for PTSD.

Childhood gender nonconformity was reported across all sexual orientations; fully 85 percent of youth who were gender nonconforming when they were young were heterosexual in adulthood.

Women who ranked in the top 10 percent for gender nonconformity before age 11 reported a higher prevalence of all forms of childhood abuse both before age 11 and between 11 and 17, as compared with women falling below the median.  Men in the top 10 percent for nonconformity in childhood had a higher prevalence of sexual and physical abuse before age 11 and psychological abuse between 11 and 17. Both groups had a higher prevalence of PTSD as adults.

“Because we used a broad definition, our ‘high nonconformity’ group was actually 10 percent of the sample,” notes Austin, the study’s senior investigator. “That’s 1 in 10 children — a large group of kids who are at higher risk for abuse, present in every classroom and neighborhood.”

Austin and colleagues urge pediatricians and school health providers to consider abuse screening for these children and advise parents that they may need to do more to protect and support them. “People need to be aware that discrimination and abuse targeting gender-nonconforming children are widespread, affect kids at a very young age and have lasting impacts on health,” Austin says. “These vulnerable children need our care and protection.”

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National children’s charity, School-Home Support UK (SHS), revealed that of the 13,000 children they support each year, most of them on Free School Meals (FSM), nearly half don’t feel safe at home. SHS identifies and supports children who have trouble being in school and being ready to learn.

SHS’s annual survey revealed that, in the preceding twelve months, their school-based professionals dealt mainly with children in homes where financial problems or poverty, the threat of homelessness, poor housing conditions, domestic violence, family breakdown or bereavement and mental health issues were prevalent.

SHS Chief Executive, Jan Tallis, commented “Children worry greatly about home and this can mean that they find it difficult to fully engage with their education. Nearly one million kids truant on a regular basis but many are afraid to leave home for school in case something awful happens or because their basic support needs – such as clean clothes or breakfast – are not being met. When we do get them into school they often exhibit poor concentration and disruptive behaviour.

This affects their ability to learn, affects peer learning in the classroom and creates a route to poor attainment and success later in life. With the highest ever recorded number of young people not in education, employment or training (NEET) this is clearly a very big issue.”

Tallis says they expect to see an increase in these figures over the next twelve months as economic hardship escalates, impacting on other issues such as mental and domestic wellbeing. SHS creates early interventions to tackle these problems in the personal and home lives of children so they can improve attendance and behaviour at school.

“Our main aim is to ensure all children stay in school and do well so they can achieve their dreams and enjoy good lives. A recent survey among disadvantaged children revealed many don’t think they will go to university, have a good job or earn good money. This is tragic,” says Tallis.

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The new ifocus computer game, launching soon for children ages 6 to 12 to improve attention, concentration and memory, has been endorsed by top brain imaging specialist Daniel Amen, MD, CEO and medical director of Amen Clinics a world leader in applying brain imaging science to clinical practice.

A Distinguished Fellow of the American Psychiatric Association, Dr. Amen serves as Assistant Clinical Professor of Psychiatry and Human Behavior at the University of California, Irvine School of Medicine where he teaches brain imaging in clinical practice.

According to Dr. Amen, “ifocus was developed in a thoughtful way to actually enhance brain development, and we have clinical evidence to prove that it does exactly that.  We conducted a very sophisticated neuropsychological assessment of a large group of children before and after they played the game, and analyzed their attention and impulse control.  It was very exciting to actually see significant improvement in their scores.

“As a child psychiatrist, I believe if you can help a child regulate their emotions, they will be much happier in their lives.  Self-regulation is critical to focus because if you can control your own attention, you can stay on track and accomplish what you need to accomplish for long-term success, despite the many distractions that all of us face today,” he said.

The centerpiece of ifocus is Jungle Rangers, a fun computer game which improves mental function through the repeated, structured practice of tasks which challenge kids in an enjoyable and motivating manner.  While playing different types of games along the path to becoming a “Jungle Ranger”, children are actually performing cognitive brain exercises to improve their focus, attention, and memory.

In addition to the Jungle Rangers game, ifocus emphasizes a holistic approach with parents’ handbooks, CDs, and Quick Start cards to explain how behavior, exercise and nutrition can impact children’s focus and attention.  ifocus was developed under the leadership of some of the world’s top scientists in pediatric neuropsychology and physiology.

The product is being marketed directly to consumers via television, radio and online. ”I have four children and five grandchildren, and frequently tell them how important it is to ensure that they have many options in life by taking care of their brains and bodies whether it’s the food they eat, the kids they play with, or the video games they play.

With ifocus, we have found specific, clinical evidence that it helps children with two of the most critical important keys to success, self-regulation and emotion,” said Dr. Amen.

Focus Education Co-Founder and CEO Michael Apstein explained that the game’s animation and storyline keeps kids interested and challenged while they are actually engaging in brain process stimulation using integrated neuro-technology.  Research has shown that improvements in the cognitive process can help children overcome distractions, attain more effective levels of concentration, improve memory and decrease frustration during problem solving.

Parents are able to monitor their children’s progress using the Jungle Rangers Dashboard which provides a personalized report card on the amount of time spent on each task within the game, as well as which tasks the child excels at and which ones need additional practice.  The best indicators, however, are the significant changes that parents experience including fewer calls from school, better grades and an easier, more organized home life.

The ifocus development team recommends that a child play Jungle Rangers 30 minutes a day five days a week for six weeks in order to experience improvement in the ability to absorb, store and manipulate information without distractions.  Just like a bad habit that is formed over time, so too are good habits such as the cognitive skills developed by children who play the game consistently.

“We believe so strongly in our product that our Parent-to-Parent Promise allows consumers to returnifocus with a full 100 percent money back guarantee for six months if they don’t see the results we’ve promised.  Besides the changes they’ll see in their children in just a couple of weeks, with our game dashboard parents will see visual proof of a child’s improvement in focus and attention,” said Apstein.

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The total lifetime estimated financial costs associated with just one year of confirmed cases of child maltreatment (physical abuse, sexual abuse, psychological abuse and neglect) is approximately $124 billion, according to a report released by the Centers for Disease Control and Prevention, published in Child Abuse and Neglect, The International Journal.

This study looked at confirmed child maltreatment cases, 1,740 fatal and 579,000 non-fatal, for a 12-month period. The lifetime cost for each victim of child maltreatment who lived was $210,012, which is comparable to other costly health conditions, such as stroke with a lifetime cost per person estimated at$159,846 or type 2 diabetes, which is estimated between $181,000 and $253,000.  The costs of each death due to child maltreatment are even higher.

“No child should ever be the victim of abuse or neglect – nor do they have to be.  The human and financial costs can be prevented through prevention of child maltreatment,” said Linda C. Degutis, Dr.P.H., M.S.N., director of CDC′s National Center for Injury Prevention and Control.

Child maltreatment has been shown to have many negative effects on survivors, including poorer health, social and emotional difficulties, and decreased economic productivity.  This CDC study found these negative effects over a survivor’s lifetime generate many costs that impact the nation’s health care, education, criminal justice and welfare systems.

Key findings:

• The estimated average lifetime cost per victim of nonfatal child maltreatment includes:
• $32,648 in childhood health care costs
• $10,530 in adult medical costs
• $144,360 in productivity losses
• $7,728 in child welfare costs
• $6,747 in criminal justice costs
• $7,999 in special education costs
• The estimated average lifetime cost per death includes:
• $14,100 in medical costs
• $1,258,800 in productivity losses

Child maltreatment can also be linked to many emotional, behavioral, and physical health problems. Associated emotional and behavioral problems include aggression, conduct disorder, delinquency, antisocial behavior, substance abuse, intimate partner violence, teenage pregnancy, anxiety, depression, and suicide.

Past research suggests that child maltreatment is a complicated problem, and so its solutions cannot be simple. An individual parent or caregiver’s behavior is influenced by a range inter-related factors such as how they were raised, their parenting skills, the level of stress in their life, and the living conditions in their community.  Because of this complexity, it is critical to invest in effective strategies that touch on all sectors of society.

“Federal, state, and local public health agencies as well as policymakers must advance the awareness of the lifetime economic impact of child maltreatment and take immediate action with the same momentum and intensity dedicated to other high profile public health problems –in order to save lives, protect the public’s health, and save money,” said Dr. Degutis.

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Hospice of the Western Reserve is kicking off a program to recognize “Hospice Heroes,” a community of individuals, families, and school, church or service groups across Northern Ohio who host fundraising activities that help the non-profit agency provide care to all who need it, regardless of their ability to pay.

Last year, the hospice covered unreimbursed expenses and charity care valued at nearly $5 million in the Northern Ohio region. According to Bill Sluzewski, development officer, fundraising events range from simple activities like selling candy bars, to larger events, like craft shows, benefit concerts and golf outings. “The organizers are often family members or friends of a patient who had been in our care,” he explained.

“Whether it’s a one-time activity or an annual event, it’s a legacy of love that honors their loved one and keeps their memory alive by giving back to other patients and families.” Such is the case for “Misty’s Wish,” created in 2010 by Sherri Viccarone, a resident of Cleveland’s West Park neighborhood, in loving memory of Misty, her teenaged daughter.

Misty, who was diagnosed with a fatal brain tumor, was cared for by Hospice of the Western Reserve during the final stage of her life.  The non-profit agency serving Ashtabula, Cuyahoga, Geauga, Lake, Lorain and Summit Counties, offers one of the few pediatric hospice and palliative programs in the country.

Hospice helped with Misty’s medical supplies, medicine, physical and psychological therapies, and also supported Sherri and the extended family by guiding them the complex healthcare maze and providing emotional and spiritual support throughout the illness.  They also gave Misty an unexpected gift.

One day, a hospice team member asked Misty if there was one wish she would like to have granted before she died. Her response was a surprise to everyone: “I want my Dad to adopt me.” (Her stepfather was the only father she had known as she was growing up.) Within just ten days, Hospice of the Western Reserve’s legal team worked with a Cleveland judge to grant Misty’s wish to be legally adopted.

When Misty died, her mother, Sherri, was determined to tell her story to help other families coping with their children’s terminal illnesses, and to keep her daughter’s memory alive.  She started out by organizing an event called the “Misty Viccarone Christmas Memorium,” which involved collecting teddy bears and donating them to the Cleveland Clinic’s Oncology Department for children undergoing cancer treatment.

In 2010, Mrs. Viccarone and a dedicated group of volunteers expanded upon initial efforts by hosting a commemorative fundraiser with bowling, raffles and prizes. They called the event “Misty’s Wish,” a reference to the final wish Hospice of the Western Reserve helped to fulfill.

The event raised more than$5,000 for the non-profit agency’s pediatric palliative care patients. It was so successful that the group decided to make it an annual event.  Last year’s event, held at Yorktown Lanes in Parma Hts., generated an incredible $8,600. Mrs. Viccarone acknowledges that having a child diagnosed with a terminal illness is something no parent can ever anticipate or be equipped to deal with emotionally or psychologically.

However, she is determined to create something positive from the tragic circumstances.  An important part of her mission is helping other parents and caregivers by expanding awareness of pediatric palliative care.

“When I first tell people about the mission of Misty’s Wish, they’re sometimes shocked and surprised,” she said. “There’s a misconception that hospice care is only for the elderly.  In fact, a co-worker who even knew Misty had died of a brain tumor asked me why there was a need for a pediatric hospice team.

My answer was simple: `Because children die.’” Misty died on July 27, 1996, but thanks to the love and dedication of her family and friends, her memory lives on to help others through Misty’s Wish.

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