American Thoracic Society: Clinical Practice Guideline on ILD in infancy

The American Thoracic Society has released new clinical practice guidelines on the classification, evaluation and management of childhood interstitial lung disease (chILD) in infants.

Childhood ILD includes a diverse group of rare lung diseases found in infants, children and teens that involve the interstitial tissues of the lung, which surround the air sacs (alveoli) in the lung and airways (breathing tubes).

It is not known how many children have these disorders. Some types of chILD are caused by other diseases, while the cause is unclear in others, and prognosis varies by disease type.

The new guidelines appear in the August 1 American Journal of Respiratory and Critical Care Medicine.

"The characteristics and natural history of ILD differ in children and adults," said Geoffrey Kurland, MD, of the Division of Pediatric Pulmonology at the Children's Hospital of Pittsburgh and a member of the committee that drafted the guidelines.

"These new guidelines specifically address the diagnostic evaluation and management of chILD in neonates and infants, as most of the new diagnostic entities that have been recently described affect infants disproportionately."

The guidelines' recommendations include the following:

Diagnosis:

• Once other possible causes of lung disease symptoms have been eliminated, "chILD Syndrome" can be diagnosed if at least three of the following four criteria are present: (1) respiratory symptoms (cough, rapid and/or difficult breathing, or exercise intolerance), (2) respiratory signs (tachypnea, adventitious sounds, retractions, digital clubbing, failure to thrive, or respiratory failure), (3) hypoxemia, and (4) diffuse abnormalities on a chest radiograph or computed tomography (CT) scan. 
• In patients with chILD Syndrome, diagnostic testing should be performed to determine the exact chILD diagnosis and echocardiography should be performed as part of the initial evaluation to rule out structural cardiovascular disease and pulmonary hypertension.
• If thin section CT is performed, the lowest radiation dose that provides adequate diagnostic information should be used.
• For neonates and infants with chILD Syndrome in whom other diagnostic investigations have not identified the precise chILD disease, or in whom there is clinical urgency to identify the precise chILD disease, surgical lung biopsy should be performed, preferably using video-assisted thoracoscopy rather than open thoracotomy. 
• Appropriate genetic testing should be performed.

Management:

• As there have been no controlled trials of any therapeutic interventions in chILD Syndrome, management is based upon indirect evidence, case reports and clinical experience. 
• For infants with severe, life threatening chILD diseases, referral to a pediatric lung transplantation center after discussion with the family is recommended.
• Given the limited evidence of a beneficial effect on clinical outcomes and the well-known side effects of immunosuppressive medications, the decision about whether or not to initiate a trial of immunosuppressive therapy must be made on a case-by-case basis. Considerations include the severity of disease, rate of progression, prognosis without treatment, co-morbidities and family values and preferences. 
• All patients with chILD Syndrome should receive supportive and preventive care, including treatment of co-morbidities and prevention of infection. 
• Families of patients with chILD Syndrome should receive education and support from care providers.

Research priorities:

• Establish accurate incidence and prevalence rates of specific chILD diagnoses. 
• Determine the natural history and clinical phenotypes of specific chILD diagnoses and their relationships to adult pulmonary disease through international databases. 
• Further delineate the mechanisms underlying chILD diagnoses. 
• Conduct multicenter studies of protocol-driven diagnostic, therapeutic and quality approaches to chILD Syndrome to ascertain the optimal methods of clinical evaluation and management. 
• Create high-quality, accessible tissue repositories and biobanks to enhance research efforts 
• Promote common terminology for chILD diagnoses and their continued inclusion in future revisions of The International Classification of Diseases (ICD).

"As our understanding of the distinctions between adult and child ILD developed, the need for clinical practice guidelines on the diagnosis and management of chILD became clear," said Dr. Kurland.

"These guidelines should help clinicians navigate the evaluation and management of children with this complex constellation of diseases."

Children with fever: Researchers distinguish between bacterial from viral infections

Using microarray technology, researchers can distinguish between viral and bacterial infections in children with fever by profiling the activity of genes in a blood sample.

While more research is needed, the new technology could one day help to identify the cause of illness and ensure that children get the right treatment. 

Credit: Robert Boston, Washington University in St. Louis

In children with fever but no other symptoms of illness, it is difficult to know whether a child has a viral infection that will resolve on its own or a potentially serious bacterial infection that requires antibiotics.

Now, researchers at Washington University School of Medicine in St. Louis report that they can distinguish between viral and bacterial infections in children with fever by profiling the activity of genes in a blood sample.

In a small study, analyzing genes in white blood cells was more than 90 percent accurate, far better than the standard diagnostic test, which is only correct about 70 percent of the time.

The research is published July 15 in the Proceedings of the National Academy of Sciences Online Early Edition.

While more work is needed, the study's results support the notion that analyzing the activity of the body's genes in response to childhood infections could help to identify the cause of illness and ensure that children get the right treatment.

Gregory Storch

"It's a common problem that children develop a fever without any apparent cause," says senior author Gregory Storch, MD, the Ruth L. Siteman Professor of Pediatrics and chief of the Division of Pediatric Infectious Diseases at Washington University School of Medicine and St. Louis Children's Hospital.

"Some of these kids have serious bacterial infections that can be life threatening, but the largest number have viral infections. The trouble is, from a practical standpoint, it's hard to know which is which."

As a precaution, many children who have a fever without an apparent cause are treated with antibiotics even though the drugs don't work against viruses and overprescribing them contributes to antibiotic resistance.

The new study involved 30 children ages two months to 3 years who had fevers above 100.4° F but no obvious signs of illness, like a cough or diarrhea.

Twenty-two of the children were known to have viral infections based on previous extensive genomic testing that is not yet practical to use in a clinic setting, and eight others children had bacterial infections.

But Storch and his colleagues at the university's Genome Institute and the Genome Technology Access Center wanted to know whether a test called a gene expression microarray could identify patterns of gene activity in white blood cells that could discriminate children with viral infections from those with bacterial infections.

White blood cells are the immune system's first line of defense against foreign invaders, and the scientists theorized that they would respond differently to viruses than to bacteria.

The researchers also had access to results of a standard diagnostic test performed when the children initially were evaluated with fevers at St. Louis Children's Hospital.

That test involves analyzing the number of white blood cells in a blood sample. Generally, the counts are elevated for bacterial infections and either low or normal for viral infections.

More information: Storch GA, Crosby SD, Yu J, Hu X. Gene expression profiles in febrile children with defined viral and bacterial infection. Proceedings of the National Academy of Sciences. Online July 15, 2013. www.pnas.org/cgi/doi/10.1073/pnas.1302968110

Good kidney health begins before birth

Researchers have found that conditions in the womb can affect kidney development and have serious health implications for the child not only immediately after birth, but decades later. 

In a paper published today in The Lancet an international team, including Monash University's Professor John Bertram and the University of Queensland's Professor Wendy Hoy, reviewed existing, peer-reviewed research on kidney health and developmental programming - the effects of the in utero environment on adult health.

Wendy Hoy

The accumulated evidence linked low birth weight and prematurity - risk factors for high blood pressure and chronic kidney disease later in life - with low numbers of the kidney's filtration units or nephrons.

In Australia, around 30 per cent of the adult population has high blood pressure and one in nine has at least one clinical symptom of chronic kidney disease.

The incidence of both diseases is significantly higher in Indigenous populations. Professor Bertram, Head of the Department of Anatomy and Developmental Biology, has been researching nephrons for two decades.

"The kidney is particularly sensitive to life before birth because we stop making nephrons at 36 weeks gestation. So, for a baby born at term, the process of nephron formation is finished and it cannot be restarted," Professor Bertram said.

John Bertram

Humans are born with an average of one million nephrons and lose up to 6000 each year. However, Professor Bertram's research has shown there is a huge variance in nephron number - from just over 200,000 to around two million.

Further, nephron number is positively related to birth weight - a low birth weight equates to low nephron number and larger babies have a higher nephron number.

Given that low birth weight occurs in 15 per cent of live births worldwide, the study has implications for maternal health and clinical screening processes.

"In terms of maternal health during pregnancy, things like a high fat diet, alcohol consumption, various antibiotics and stress hormones have been shown to have a negative impact on foetal kidney development, although more research needs to be done," Professor Bertram said.

"Further, given the strong associations between birth weight, nephron number and disease later in life, and the fact that a baby's weight is routinely recorded in many countries, we suggest that birth weight should be a parameter that clinicians use to determine how often a patient is screened for kidney function or given a blood pressure test.

"Although a newborn may appear perfect, if their birth weight is low, there may be consequences 40 years down the line. We could be proactive about detecting these diseases in the early stages."

Child Poster: Children Need and Deserve Patience

If it takes a poster to help you remember that children need and deserve your patience and understanding to help them learn, then use this poster to help you.

Here are some more quotes to amuse and inform you.

"School is indeed a training for later life not because it teaches the 3 Rs (more or less), but because it instills the essential cultural nightmare fear of failure, envy of success, and absurdity."

Jules Henry

"Schools have not necessarily much to do with education...they are mainly institutions of control where certain basic habits must be inculcated in the young. Education is quite different and has little place in school." 

Winston Churchill

“School prepares for the alienating institutionalization of life by teaching the need to be taught.” Ivan Illich

Online Child Protection : CEOP UK Video

'The Parents' and Carers' Guide to the Internet', from CEOP, is a light hearted and realistic look at what it takes to be a better online parent. The show covers topics such as, talking to your child about the technologies they use and the things they might see, such as pornography.

With interviews from leading experts such as, Professor Tanya Byron, Dr Linda Papadopoulos and Reg Bailey, as well as key industry players from Facebook, Club Penguin and Moshi Monsters , this online guide aims to equip you with the tools to have those tricky conversations with your children and keep your family safe online.

Parental child abductions 'rise by 88% in a decade'

The number of children abducted and taken abroad by an estranged parent has risen by 88% in just under a decade, according to new government figures.

About 270 new cases were reported in 2003-4, while this year so far there have been more than 500 new cases, data from the Foreign Office (FCO) showed.

It is illegal for a parent to take a child overseas without permission from others with parental responsibility.

But 24% of Britons are unaware it is a crime, separate FCO research suggested.

The FCO has launched a campaign to highlight the issue.

"We know that before or during school holidays is one of the most common times for a child to be abducted," said Daisy Organ, the head of the FCO's child abduction section.

'Think twice'

"We hope that this campaign will help inform and educate the UK public and encourage parents thinking of abducting their child to think twice before they cause significant distress to themselves and their family."

Alison Shalaby, chief executive of the charity Reunite, said: "It is important to remember that parental child abduction is not faith or country specific - 71% of the UK public thought that parents most commonly abduct their children to the Middle East, India and Pakistan but it can happen to anyone, from any background."

She said children had been abducted by a parent and taken to France, Australia, Thailand and many other countries, some of which had few processes in place for returning such children.

Between 2001 and 2011 there was a 206% increase in the number of children taken to a country which had not ratified the Hague Convention on child abduction, an international agreement between certain countries which aims to ensure the return of a child who has been abducted by a parent.

According to the FCO research, 74% of people thought fathers were most likely to abduct their children but statistics from Reunite International suggest 70% of their cases concern mothers taking the child.

Why Advocating for a Child with Dyslexia is so Difficult

Advocating for a child with dyslexia or suspected dyslexia can be tantamount to moving a cruise ship with a piece of string and your teeth but if you pull hard enough and you give the ship enough fuel to move, you can make progress.

Once you set sail the whole ordeal will be worth the struggle. So, why is it so difficult to get appropriate services or even recognition of a problem from most schools?

“Dyslexia is a broad term that covers a lot of different issues.” If I had a dime for every time I heard this mantra that has been adopted by countless participants at IEP meetings, I would have a lot of dimes.

I have to admit, I have had to control my smirk when I hear this mantra and wait for my turn to set the record straight.

The fact is the opposite is true. Dyslexia has a very narrow definition and only includes those students with a phonological processing problem (www.interdys.org for a complete and official definition).

It can be identified with the correct battery of tests that are correctly interpreted.

Solution: Be prepared for this response and do your homework. Bring FAQ sheets with you about dyslexia, ask them about their training in dyslexia, and ask them what they think dyslexia is and how they came to this conclusion and do so in collegiate manner – it’s an academic conversation not an accusation.

Dyslexia is so hotly debated that is important to remain calm in order to truly teach the team about it. Be prepared to compromise and pick your battles.

If they seem to understand the underlying cause of the reading/spelling trouble and seem willing to provide the appropriate strategies, then accept the label Specific Learning Disability.

Last but certainly not least, remind them that dyslexia is listed as one of the conditions under Specific Learning Disability.

This is where the humour comes in: Dyslexia is too broad, but it is listed as one of the eligible conditions.

Specific Learning Disability encompasses every learning disability but it is not too broad? Do you see why I am smirking now? Silly, right?

Read mor eof this article here: Putting the D in to the IEP

Child Development: Talk to your babies

Talk to your babies | ScienceBlog.com

Northwestern University researchers have found that even before infants begin to speak, words play an important role in their cognition. For 3-month-old infants, words influence performance in a cognitive task in a way that goes beyond the influence of other kinds of sounds, including musical tones.

The research by Alissa Ferry, Susan Hespos and Sandra Waxman in the psychology department in the Weinberg College of Arts and Sciences, will appear in the March/April edition of the journal Child Development. In the study, infants who heard words provided evidence of categorization, while infants who heard tone sequences did not.

Three-month-old infants were shown a series of pictures of fish that were paired with words or beeps. Infants in the word group were told, for example, "Look at the toma!" ?-- a made-up word for fish, as they viewed each picture. Other infants heard a series of beeps carefully matched to the labeling phrases for tone and duration. Then infants were shown a picture of a new fish and a dinosaur side-by-side as the researchers measured how long they looked at each picture. If the infants formed the category, they would look longer at one picture than the other.

The Child's Developing Brain needs play

Scientific research has established that the major part of the development of human brain happens in a child’s first three years of life. These first three years of pre-school life is the most impressionable period of human brain during which new neural networks are being formed in certain parts of the brain.

A child who is one year old has the maximum number of brain cells the human brain can have in its entire life span. Neurobiologists believe that about 10 billion nerve cells in the infant brain are constantly making the synapses that promote thought, emotion, and physical movement. The capacity to form such neural connections depends on whether the infant brain receives proper stimulation.

Sensory stimulation such as listening to speech or watching colors or emotional stimulation by getting hugs or eye contact can change the physiological development of infant brain by changing the quality and quantity of the electrical wiring between brain cells. This promotes the growth of dendrites in the brain making stronger and richer neural connections.

Different parts of infant brain get stimulated in different ways when infant brain experiences different emotions leading to connections between different synapses. Infants who experienced playful teaching by happy adults or teachers in a fun environment showed considerable neural activity in areas of brain which specialized for positive emotion.

When such infants grow up into adulthood, they are more like to feel positive and stay positive even when they experience a negative or stressful event in their environment. Such stimulation of the infant brain can determine whether the infant will grow into peaceful & happy adult or a violent antisocial troublemaker.

To read the full article click here

Dyslexia: Understanding your child's difficulties

Evaluating your child's reading needs, planning their program, monitoring progress and requesting suitable modifications and changes along the way, requires you to have responsive and appropriate answers to many practical questions.

• If my child is not performing at the correct level, at what level are they performing?
• What do they need to learn that they are not currently learning? Where is the gap?
• What services and instructions do they need to improve to support their learning? How do we fill that gap?
• How do we compare and monitor the progress made?

A question that you need to ask yourself is whether the school is giving you the correct information. Are you getting accurate and appropriate answers in the right context? Are you getting all the answers you require? Do you feel you have the knowledge or level of expertise to manage the situation?

It is one of the greatest burdens that fall on parents, being the carer and manager of your child's education, intervention and educational progress. You are told that 'the more you know and understand about your child's learning difficulties, the better your child will do.'

What a huge burden that places on you. It is no easy task. It is a diverse and complex role that is difficult to excel in but you are compelled to play it. If it seems too large, seek help. Share the burden with like-minded people, other parents and carers that are experiencing or have experienced a similar situation.