Child Health Alert Newsletter November 96

Child Health ALERT

Volume 14 A Survey of Current Developments Affecting Child Health Care November 1996

The Role That Breakfast Plays In Children's Learning

Even though generations of parents have told their children that a good breakfast was an important way to start the school day, there hasn't been much scientific research on the subject. We do know that eating breakfast increases the blood sugar level, and researchers have shown that fairly small increases in blood sugar can increase learning ability; there are also other suggestions that breakfast might improve a child's learning ability.

To see whether children who eat breakfast improve their short-term learning capacities, researchers in Israel conducted a study of 569 children aged 11 to 13 years in two different test situations. In the first, the children were asked what they had eaten for breakfast the morning of the test, and it turned out that those who had eaten breakfast performed significantly better on tests of immediate recall than those who had not eaten breakfast.

In the second situation, the authors took two thirds of the children and enrolled them in a two week program that provided them a daily breakfast in school (at around 8 AM) that consisted of sugared corn flakes and about a cup of milk. The remaining one third of children were not provided breakfast in school and were given no instructions regarding breakfast habits. All the children were tested around 9 AM. In their analyses, the authors compared the children who ate at school with the other children, some of whom ate breakfast at home and some of whom did not eat breakfast at all.

When they looked at test results for the children who were not given breakfast at school, the authors found that on most tests the children who routinely ate a small breakfast 1.5 to 2 hours before testing did not perform better than those who started the day without any breakfast. On the other hand, when they looked at results for the children who had become accustomed to eating breakfast at school, they found that these children performed significantly better on almost all tests than the children who had eaten breakfast at home or the children who had not eaten breakfast at all. The authors point out that these findings "may indicate the importance of timing or the possible importance of breakfast content".

Since the children who were provided breakfast in school ate only an hour before testing, the results might be explained by the fact that their blood sugar was elevated at just the right time (that is, close to the time of testing). On the other hand, it may be the different kinds of foods eaten for breakfast that explain the results, since the usual breakfast that children ate at home might not have had enough nutrients to provide an elevation in blood sugar when the testing took place (and certainly that would be the case for children who ate no breakfast).

The authors make the general conclusion that meals may play a role in the learning process and suggest that the effect of breakfast may come from having an increased blood sugar level at the right time. (Vaisman N et al: Archives of Pediatric and Adolescent Medicine, benefits (pp. 1089- 1092, October, 1996)

COMMENT: This report received a great deal of media attention, but parents may have been misinformed about the results. All the reports we saw suggested that having breakfast immediately before taking a test will improve test scores, but that is not what the data show or the authors conclude. Timing may be one factor, but the content of breakfast may be another. In fact, the authors even raise possibility that test results might have improved simply because children were having breakfast in school, perhaps because of change in routine, the social benefits of a group breakfast, or any number of other explanations.

Contrary to what some news reports might have implied, the authors of this study don't suggest that parents try to time breakfast exactly an hour before their child will be tested; rather, they see their results as further evidence that breakfast may play a role in learning, and call for more research on this important subject.

INFECTIONS/ILLNESS

Good News About Lyme Disease In Children

Lyme disease is caused by bacteria transmitted by the bite of a few species of ticks; it was first recognized in the area of Old Lyme, Connecticut, about 20 years ago, and it has become a relatively common problem in both adults and children in areas where the ticks are plentiful. The illness can include a wide range of problems, from a mild rash with flu-like symptoms to chronic arthritis and neurologic problems. If treatment is begun early, antibiotics can substantially reduce the risk of long- term complications, but there are many questions about the way antibiotics recommend treatment for 2 to 4 should be given. Some people weeks, while others recommend longer treatments; most doctors use oral antibiotics, but some believe intravenous antibiotics are necessary To answer some of these trouble some questions about Lyme disease and its treatment in children, researchers in southeastern Connecticut identified all children from five pediatric practices who were diagnosed with Lyme disease between April, 1992 and November, 1993. The authors considered whether the children were seen early in their illness (when they had a rash, flu-like symptoms, or certain other problems) or whether they were first diagnosed when they already had advanced complications of Lyme disease (such as arthritis). Therapy was chosen by each child's pediatrician, and consisted of oral or intravenous antibiotics for varying lengths of time. In all, the doctors saw 201 children with newly diagnosed Lyme disease, with an average age of about 8 years. The vast majority (94%) had early disease, while 6% had arthritis when they were first seen. Among the children with early symptoms, the vast majority (89%) were diagnosed in June, July, or August.

In almost all the children, the problem that brought them to the doctor was a rash; less than two thirds were aware of a tick bite in the preceding month. Rashes were most often located on the head or neck, arms or legs, or back, though they were sometimes seen on the abdomen, armpit, groin, and chest.

Virtually all patients were treated with oral antibiotics for 2 to 4 weeks, and after 4 weeks 94% were completely free of symptoms. Among the few children who continued to have symptoms (such as fatigue and joint or muscle aches), the problems weren't enough to pre vent them from participating in play or school. When the researchers followed-up the children about two years later, none of the Lyme disease children had objective evidence of continuing problems caused by Lyme disease, though one parent reported a child with continued mild joint pain.

The authors conclude that "the prognosis is excellent for those with early Lyme disease who are treated promptly with conventional courses of antimicrobial agents." (Gerber MA et al: New England Journal of Medicine, pp. 1270-1274, October 24, 1996)

COMMENT: With all the doom and gloom we hear about Lyme disease and its complications, particularly in adults, this report from Connecticut offers some very good news for children and their families. An important question to ask, though, is how can all areas of the country where Lyme disease is a problem have the same success as was reported in southeastern Connecticut?

Since southeastern Connecticut has one of the highest rates of Lyme disease in the country, parents there are undoubtedly very informed and watchful for early signs of the disease and doctors are quite experienced in its diagnosis and treatment. If the good results from this study are to be matched elsewhere, parents and physicians in other regions will need to be similarly alerted to the early signs of Lyme disease so that children can be diagnosed and treated promptly.

Apple Cider Caution

Though publicity about infections from certain E. coli bacteria has diminished, it is still important to be aware that raw apple cider can be contaminated with these organisms (the same ones that are found in undercooked hamburger -see CHILD HEALTH ALERT, October, 1994; September 1993). The bacteria come from cow feces, and they can contaminate apples that have fallen on the ground near cow pastures. At a minimum, apples used for apple cider should be thoroughly washed and brushed, but the best way to be safe is to make sure that the apple cider that you serve to everyone has been pasteurized.

IMMUNIZATION

Which Polio Vaccine To Use?

One of the remarkable public health successes in recent decades has been the elimination of polio from North America. This success has been the direct result of wide spread use of two polio vaccines. The first vaccine, developed by Dr. Jonas Salk, was made from polio viruses that had been "inactivated" (more to the point, they were killed); it produced good levels of immunity, but had to be injected with a needle. The second vaccine, developed by Dr. Albert Sabin, was made from polio viruses that had been "attenuated" (they were not killed, but so weakened in the laboratory that they weren't believed to be capable of causing polio); this vaccine also produced good levels of immunity, but because it could be given by mouth it became the major polio vaccine used in the U.S. It has been given to children in a series of four doses as part of their routine childhood immunization schedule.

Although the vaccines eliminated natural polio infection, every year there were a few cases (perhaps a dozen) in which children developed polio from the weakened but still live virus in the oral polio vaccine. After much debate among vaccine and public health experts, the U.S. Centers for Disease Control recently changed the recommendation for the polio vaccine schedule. Instead of four doses of the oral vaccine, it now recommends that the killed vaccine be used for the first two doses and the live vaccine be given for the last two; the objective first doses of killed vaccine polio to protect against the very tiny risk of contracting polio from the second two doses of live vaccine. (Various sources, including New York Times September 20, 1996)

COMMENT: The controversy that centers around the polio vaccine can be confusing, and it is worth clarifying that both vaccines are effective in preventing polio, and the debate is over the pros and cons of using each one. From one perspective, switching entirely to the killed vaccine would provide good immunity without any risk of a child contracting polio from the vaccine. However, the killed vaccine has to be given as a shot, and many public injection health experts fear that it will be more difficult to get children to complete their full immunization series for polio and other childhood diseases if more shots are added to a schedule that is already crowded with injections.

Thus, while switching to the injected polio vaccine might eliminate the extremely few cases of polio that result from the oral vaccine, the cost of doing this might be an increase in many vaccine preventable illnesses because children would be less likely to get their full series of immunizations. So the real issue is balancing efforts to eliminate the tiny risk of any vaccine related cases of polio against the need to assure that children are fully immunized against the wide range of childhood diseases.

There is no easy answer to this problem, and the CDC acknowledged the controversy by stating that physicians could still choose to stay with the four doses of oral polio vaccine, could switch to the two injections and two oral doses, or could Pediatrics, Ha Medical School, switch entirely to four injections. What is critical to understand is that, whatever immunization approach is used, no responsible public health expert is suggesting that children avoid receiving their full series of polio immunizations.

CHILD SAFETY

More On School Bus Safety

Last month, we featured a new, simple, and potentially effective way to increase children's safety behavior while they wait for the school bus. Researchers from Connecticut found that children's behavior improved when schools implemented a program that involved painting a stencil outline of a school bus on the sidewalk pavement at least 10 feet from the curb and an educational intervention aimed at increasing children's awareness of the hazards of unsafe behavior while waiting for the bus. We have followed-up on this interesting idea to provide readers some additional information:

Materials are available in a variety of packages and costs. An informational packet can be obtained free of charge; a parent's kit, for $24.95, includes a paper stencil of a school bus (measuring 11 x 14.5 inches) and instructional materials needed for the educational component; the institutional kit, for $139.95, includes a brass version of the school bus stencil intended for use by school systems. The various materials can be obtained from Bus Stoppers Inc., P.O. Box 65, El Cerrito, California 94530; for more information, call (800) 379-9040.

COMMENT: The research supporting the value of this effort was published in a medical journal, as we noted last month; it's important to remember that the positive results were attributed not just to the stencil on the pavement, but to the educational efforts that accompanied it. The stencil may have other value besides marking the pavement outdoors--it can also be used indoors as a learning tool, perhaps by making a mural on the subject of school bus safety, with the stencil as the focal point.

RESOURCES

Helpful Information About Child Development

The National Association for the Education of Young Children (NAEYC) is conducting a communication campaign called the "Early Years Are Learning Years". It's purpose is to help parents and the public understand the importance of high quality early childhood programs that promote children's development and learning. The campaign was prompted by research that found that many parents didn't appreciate the importance of learning in a child's early years and those that did had a difficult time sorting out good programs from mediocre ones. As part of this effort, NAEYC is issuing press releases twice a month, and making this information available to consumers. These releases can be photocopied and distributed. Among the subjects covered are "Biters: Why they do it and what to do about it", "Toys: Tools for learning", and "An important bond: Your child and your caregiver".

NAEYC strongly encourages those interested to obtain the releases through NAEYC's web site (http:// www.naeyc.org/naeyc); those without access to the web at home, at work, or in their communities may have them faxed every other week. The releases are also available through e-mail by contacting jnewberger@naeyc.org. For those to whom none of these options are available, NAEYC will mail releases on a monthly basis. Send your name, address, telephone and/or fax number to Box EYLY, NAEYC, 1509 16th Street, NW, Washington, DC 20036-1426.

COMMENT: This resource offers a good opportunity to get current thoughtful material on a regular basis. The information should prove useful not only for child-care providers but also for parents.

Special Holiday Gifts: " Healthy Handwashing" Posters & Coloring Packets

A number of CHILD HEALTH ALERT subscribers have found that our "Healthy Handwashing" posters and coloring packets make excellent small gifts for the holidays--the delightful characters not only amuse, but they teach the increasingly important message about proper handwashing. The poster and coloring packet each cost only $7 for one item, and $5 for each additional item (includes postage and handling; Massachusetts residents must include 5% tax); requests and payment should be sent to "Healthy Hand washing", c/o CHILD HEALTH ALERT, P.O. Box 610228, Newton Highlands, MA 02461.

PRODUCT RECALLS

Gerry Baby Monitor...

Gerry Baby Products Co., of Thornton, Colorado, is recalling almost one million Model 602 Gerry Deluxe Baby Monitors because wires inside these devices may be improperly connected and could result in overheating and fire. Another factor that could increase the risk is blankets or other bedding placed around or on top of the monitor, blocking ventilation. The company is aware of a number of fires blamed on the baby monitor, and a number of reports where the monitors were warm to the touch.

The two-piece monitor sets resemble walkie-talkies, and have a pale gray and royal blue plastic casing. A red "on" light and a blue "Gerry" label appear on the front of each monitor, and the back is embossed with "Gerry deluxe baby monitor model 602" and the manufacturer's date code. The latter appears as a circle of numbers, with an arrow pointing to the number of the month and the two-digit year number on either side of the arrow. This recall involves monitors with date codes "8806" (June 1988) through "9005" (May 1990); it was during this period that the monitors were sold at juvenile product and baby supply stores. Consumers who have items affected by this recall should contact Gerry toll-free at (800) 672-6289 for instructions on how to return them for a free replacement monitor. For more information, call Gerry or write to the company at "Attn: Building R-602 Recall, 1500 East 128th Avenue, Thornton, CO 80241.

... And "Flip Fingers" Rattle

Gerber Products is recalling about 60,000 "Flip Fingers" rattles because the spherical end caps may separate, releasing small part that can present a choking hazard. The rattles, model number 76250, have red, U-shaped handles embossed with the word Gerber, and were sold nationwide from May to September. Consumers should call (800)-4-GERBER for instructions on how to return the rattle for a refund.

Anchor Soccer Goals

The Consumer Product Safety Commission (CPSC) is urging parents, coaches, administrators and players to be sure to anchor movable soccer goals to prevent them from tipping over and crushing children who climb or hang on them. Since 1979, movable goals have been responsible for at least 22 deaths and hundreds of serious injuries, most of which occurred with unanchored homemade goals, including those assembled by high school shop classes and local businesses. CPSC chairman Ann Brown stated that "Parents should check their children's soccer goals. If the goals aren't anchored, kids shouldn't play." For a copy of CPSC's "Guidelines for Movable Soccer Goal Safety", send a postcard with your name and address to Soccer Goal Guidelines, CPSC, Washington DC 20207.