Category Archives: Parenting

Pontine Glioma

Childhood cancer is ordinarily treatable. Although it can be scary when one’s child develops cancer, children’s resilience means cancers in children respond very well to treatment. The only exception is brain tumors, which, because it requires such precision to treat anything in the brain, are the riskiest for children. That includes a cancer of the brainstem called a pontine glioma, one of the most dangerous tumors to treat.

The brainstem is the part of the brain that controls essential function. It’s difficult to label any part of the brain the most important—the entire thing is important—but it is the brainstem in which dysfunction has the most inevitably noticeable and broadest, and widest ranging effects. The pons, where pontine glioma develops, is responsible for breathing.

Children who develop pontine glioma will have trouble walking, standing, and speaking, because the tumor affects parts of the brain that communicate with the arms and legs, as well as the speech areas. It also affects the facial muscles, making eye movement and swallowing difficult and causing one side of the face to droop. Children with this type of tumor may also have trouble closing their eyes all the way, and may have double vision. Pontine gliomas often grow rapidly, causing damage as they do.

It is not known what causes these tumors to develop. There is a type of fungal infection of the scalp that is ordinarily treated with radiation, and children who have had this radiation treatment are more prone to developing glioma of the brainstem, but not all cases can be traced to that source. In a recent study, researchers found that the genetic code of the tumor contains gene mutations that had not previously been linked to any form of cancer, and they say this may prove to be a useful diagnostic tool in the future.

Sadly, children diagnosed with pontine glioma are not expected to survive more than nine months. Fortunately, however, new treatments are being developed that could well save lives. Now that mutations linked with pontine glioma have been discovered, scientists are tracing the effects of those mutations, determining how they relate to tumor development, and finding ways to prevent tumors from developing and destroy them when they do.

Enterovirus Outbreak

Enterovirus 68 as been known for more than 50 years, but a recent outbreak that has hospitalized children across the United States has parents looking for answers. Enteroviruses are a common source of childhood illnesses, primarily causing respiratory or inflammatory disease. Most ordinary infectious diseases children get growing up result from enteroviruses. These diseases are generally fairly mild and quickly run their course, causing nothing worse than temporary discomfort. However, enterovirus 68 is on of the more severe types. Only six outbreaks were reported from 2005 to 2011, but since this past August, there have been nearly 700 cases throughout the country, resulting in five deaths.

The cold is a type of enterovirus and indeed most enteroviruses are spread like colds, through close contact. That means any sort of direct touching, or sharing eating utensils or drinking glasses, or toys. People can also pick up the virus by touching their faces after touching a surface that has the virus on it, such as a chair or table at which a sick person has recently been sitting. The spread can be prevented by washing hands and surfaces, and avoiding shaking hands with, kissing, or hugging people who might be infected. Most people with enterovirus 68 can treat it with the care given a cold—rest for a week, plenty of fluids. It is slightly more of a danger for children with asthma. It is unusual, though not unheard of, for enterovirus 68 to be deadly.

What is unusual about the August outbreak is its size. After fewer than 100 reported cases in the Unites States in half a century, the recent outbreak has seen 30 cases per day at just one hospital, with close to 700 overall over about two months. Some experts say it’s a statistical artifact, with previous cases going unrecognized, while better diagnostic techniques and greater attention by health agencies are making the virus more readily identified without actually being more common. This frequently happens with rare or recently discovered diseases. Some enterovirus 68 patients have had paralysis, but it’s not clear i or how this relates to the virus.

Multiple Births

About one pregnancy in 30 results in multiple births, two or more children born at once. Almost all of these are twins. The frequency falls off dramatically as the numbers of births goes up with triplets rarer than twins, quadruplets rarer than triplets, and five or more births almost unheard of and nearly always as a result of medical intervention of some kind. Higher order live births are rare, more often some or all of the fetuses miscarry or are stillborn. In 2013, only 66 sets of quintuplets or higher were born in the United States, and there were more than 32 times as many twin births as all higher order births combined. In all, there are about 130,000 sets of twins born every year.

Common reasons for multiple births are older mothers—twinning is more common in mothers over 30—and fertility treatments, which often involve multiple ovulation or the creation of multiple embryos as a hedge against a greater risk of losing them. Fertility drugs, which encourage ovulation, often lead to multiple mature ova in one cycle. Twinning runs in families. A woman who is a twin is likely to have twins herself. Twins can be either monozygotic, developing from a single zygote that splits, or dizygotic, in which two ova are fertilized and two entirely separate zygotes develop. Triplets are sometimes monozygotic; triplets usually, and higher order births almost always, are either strictly polyzygotic or a combination of the two.

Multiple births are prone to complication. Because multiples are so hard on the gestational environment, it is quite common—moreso as the order increases—for one or more of the fetuses not to survive. The most births ever recorded is a woman who delivered octuplets after undergoing fertility treatments, but it is very rare for all eight fetuses to survive in such a pregnancy. Although more than 90 percent of single pregnancies are carried to term, more than half of twins and 91 percent of triplets are preterm, another factor affecting survival. Because of this, multiples tend to have low birth weight and are more prone than singletons to cerebral palsy.

Congenital Heart Defects

Congenital heart defects are the most common kind of birth defect among children born in the United States, affecting nearly one percent of all newborns in the country. There are multiple kinds of heart defect, classified according to the location of the problem within the heart as well as what, specifically, is wrong. The types of heart defect include:

Complete atrioventricular canal defect, a failure of the walls separating the chambers to meet and fully close. This means blood entering the lungs mixes with blood that s to circulate to the rest of the body, causing improper oxygen distribution.

Truncus arteriosus, in which the blood vessels leading in from the lungs and out to the body are fused together, when they are supposed to be separate. This condition also interferes with proper circulation of the blood through the body.

Ebstein’s anomaly, in which the heart valve on the left side cannot fully close.

Tetralogy of Fallot, the co-occurrence of four different malformations. These are a hole between the heart’s lower chambers, the aorta right above this hole and connected to both chambers rather than only the left, a blockage in the link between the heart and the lungs, and a thickening of the wall of the right chamber.

Pulmonary valve stenosis, in which the heart valve doesn’t open all the way and blood sometimes flows back out.

Atrial septal defect, a hole in the wall separating the heart’s upper chambers.

Coarctation of the aorta, a narrowing of the artery that carries blood out of the heart. This can can lead to high blood pressure, which is dangerous in infants.

It is often important that heart defects in newborns and infants be treated, usually with surgery. Because these defects are typically diagnosed so young—symptoms are frequently apparent early on, such as the tetralogy of Fallot, which can result in blue skin—and because infants born with heart defects may have other illnesses as well, there might be limits on the types of surgery that can be performed. In some cases, however, it is possible to leave the defect as is, at least temporarily, and it is sometimes possible for children born with heart defects to grow up quite healthy regardless.

Depression And Allergies

More and more, researchers are starting to see a connection between allergies and depression. There is evidence of relationships in both directions, so allergies exacerbate depression, while depressive symptoms and affect make allergy symptoms worse. One study found that this connection is partly responsible for an uptick in suicides as winter turns into spring. Part of this is a hope that depression is merely seasonal being dashed—people tough it out through the winter but go into a decline when spring doesn’t bring improvement—but now it appears that allergens increasing in the springtime also bears on this phenomenon.

Depression is thought of as a mental illness, but the brain is part of the body, and there’s no bright line, medically speaking, between physical symptoms and mental ones. One place where this is apparent is allergic reactions causing depressive symptoms. Allergens are normally harmless substances, such as pollen, that trigger an immune response in people who are sensitive to them. Part of this immune response is inflammation. Inflammation can lead to a low feeling called dysthymia; this is why people who are sick feel awful. Dysthymia is also a symptom of depression. Some scientists have proposed that a hitherto underestimated cause of depression itself is inflammation due to allergy.

Meanwhile, stress is both a cause and an effect of depression. Depression can be a response, in part, to stress, but t can also increase it. Stress is also intimately bound up with the immune system The stress hormone cortisol temporarily suppresses the immune system, only for it to come back turned up after the stressor has passed. That means that stress, anxiety, and depression actually make allergic reactions worse, particularly on the second day. That means not only does stress directly lead to depression, it also increases depression as a result o the inflammation from an allergy attack.

In children, scientists have also found a genetic link between allergies and depression, as well as behavioral problems. While allergies themselves exacerbate depression, and allergies and depression alike are partly responsible for children misbehaving, there is evidence that genetics is behind a predisposition to allergies, a predisposition to depression, and a tendency to act out.

Measles Returns

Decades ago, measles was a common childhood disease, and complications were also common. Around one-third of people who contract measles—and it was nearly ubiquitous at one time—get some other medical condition a a direct result. The most common of these is otitis media, or a middle ear infection, which may result in hearing loss. Other complications include pneumonia, bronchitis, and encephalitis; in many cases measles can even be fatal. Measles can also cause corneal ulceration and scarring, which could lead to diminished eyesight.

These complications are largely in the past, however, thanks to measles vaccination, which became available in 1963 in the United States and was almost universal after 1977. The measles vaccine provides immunity to 95 percent of children older than one year who receive a single dose, and most of the remaining five percent develop immunity after a second dose.

During the heyday of the disease, "measles parties" to allow infected children in a community to spread the disease to their uninfected neighbors—especially the girls, because women who get the disease as adults, particularly during pregnancy, are prone to miscarriage or to having children with birth defects—were common. Measles vaccination is the same basic principle, stimulating an immune response so the disease doesn’t affect adults, but in a more certain and concentrated way with less suffering involved.

Unfortunately, measles has recently had a resurgence. In the late 1990s, false controversy began to be sown over the safety and efficacy of vaccines, and the 610 cases reported last year were the first large harvest. As parents are delaying vaccinating their children against measles—such as by rejecting the measles-mumps-rubella combined vaccine in favor of getting the three immunizations separately and spaced out—or refusing entirely, communities across the United States are seeing a growing number of measles cases, despite the disease having been declared eradicated in the Americas in 2002. In 2014, there were more than 200 cases of measles reported in the country for the first time in 17 years.

Not all parents who don’t vaccinate fear the bogeyman of alleged safety issues; some interpret religious requirements as forbidding it, and some have genuine medical reasons they can’t. However, when almost all children are vaccinated, herd immunity protects those who are not. Herd immunity means if someone is infect, even a highly contagious disease such as measles has no place to go.

Cerebral Palsy And Heredity

Damage to areas within the largest part of the brain—the cerebrum—typically before or during birth is called "cerebral palsy." This term refers not to one specific condition but is a name for a broad category of motor deficiencies that result in physical disability. The damage may result from inflammation, infection, or low birth weight or birth defects. Over half of all children with cerebral palsy have been found to have birth defects or low birth weight. Babies born with cerebral palsy may be floppy or stiff. Children with these conditions often exhibit language problems, not necessarily due to cognitive deficits—though such deficits are not uncommon—but as a result of respiratory problems or difficulties with facial muscle control.

The causes of cerebral palsy are not clear. Contrary to what was once believed, babies born with the umbilical cord wrapped around the neck, which actually happens in as many as a third of all pregnancies, are not at significantly higher risk for cerebral palsy. Rather, women who have infectious diseases such as rubella, chickenpox, or toxoplasmosis during pregnancy are more likely to have children with birth defects such as cerebral palsy. Multiple birth are associated with low birth weight, and particularly if there has been a miscarriage, one or more of the infants are at heightened risk for a form of cerebral palsy.

Researchers have also found a family connection in cerebral palsy. Siblings, children, and first cousins of children who are born with cerebral palsy are themselves at higher than normal risk of thee conditions. One study found that, while children who are twins are already three times as likely as single births to have some form of cerebral palsy, when one twin develops one, the other is 15 times more likely to do so as well. The same study showed younger siblings of children with cerebral palsy showed a sixfold increase in risk, roughly the same as children of parents with cerebral palsy.

The good news is that by adolescence, with proper treatment, children with cerebral palsy have quality of life roughly comparable to that of children who are not affected. In a survey, teenagers with cerebral palsy self-assessed as doing as well as—or better than in some areas—their peers.

Folic Acid And Health

Only 400 μg per day of vitamin B9, or folic acid, taken prenatally can help the fetus to develop normally, avoiding miscarriage and reducing the risk of birth defects by nearly three fourths. In particular, it helps prevent spina bifida, a condition in which some of the vertebrae that ordinarily cover the spinal cord don’t fully close, leading to physical problems and neurological and cognitive deficits.

However, there are other birth defects that folic acid, which is a part of the cell division process that underlies almost all tissue formation and growth, can help prevent. It helps prevent all neural tube defects, the type of birth defect of which spina bifida is among the most common, and also congenital heart defects, cleft lip, and other conditions.

To be most useful in fetal development, folic acid should be taken early in the pregnancy—the most effective time to up B9 intake is the first four weeks after conception. Most people don’t know they’re pregnant for much of that time, which is why women who might become pregnant are generally advised to get their extra 400 μg daily, in order to be sure they’re ready. However, getting a head start—being sure to get that amount even before conception—has been shown to have benefits for the future fetus.

Moreover, folic acid is beneficial in adults as well, even men. Folic acid can help prevent colorectal cancer as well as cervical cancer. It’s good for the heart, lowering the risk of heart attack and stroke. It’s also good for a large number of other things. People worried about the effects of growing older should know B9 helps slow or prevent Alzheimer’s disease and a kind of progressive vision loss called age-related macular degeneration, as well as other signs of aging. It’s good for depression and sleep problems, nerve and muscle pain, and even AIDS.

Fortunately, folic acid is easy to get. There are supplements, but most people don’t need them. Vitamin B9 is found in leafy green vegetables, asparagus, okra, bananas, beans, oranges, lemons, organ meats, mushrooms and even yeast. By law it’s added to flour as well in the United States. Inadvertently omitting folic acid from the diet would be next to impossible.

Flu Vaccine

Flu season means flu vaccine time. Th widely available influenza vaccine is one of the most effective ways to stop the spread of the contagious viral illness. The flu virus changes slightly from year to year, which is why a new vaccine is needed each season, but the vaccine provides long-term protection against each season’s specific strain of the disease.

The flu vaccine works in two primary ways. First, it prompts the immune system to produce antibodies that fight off a specific strain of influenza virus, making it easier for the body to rid itself of an infection before it can cause illness. Second, it reduces the level of flu virus in the population, so people fewer are exposed to the virus in the first place. This means the vaccine is effective even for the small number of people who do not produce sufficient antibodies in response to the vaccine, or for whom vaccination is unsafe.

In some cases people are reluctant to get vaccinated because of erroneous beliefs about the vaccine. While the vaccine does contain flu virus, it is in an inactive form, enough to trigger an immune response, but not enough to actually sicken most people. The vaccine can cause side effects in some patients, but many fears—of neurological problems, of heart disease, of Alzheimer’s—are exaggerated, or often the opposite of the case, in that flu vaccine reduces these risks. Conversely, people often liken "flu" to a bad cold, even though flu killed thousands of people per year.

There are people for whom flu vaccine is not recommended. People who have had severe allergic reactions in the past are poor candidates for vaccination. None of the types of vaccines are approved for children under six months. People who are not feeling well should get better before being vaccinated. Other people need to take precautions before vaccination. It may not be possible for people with egg allergies to receive the vaccine, and they should discuss the best course of action with their healthcare professionals. Similarly, people with Guillain-Barré syndrome are prone to complications and should talk to a doctor. Vaccination is recommended for everyone else, particularly people under four or over 50 and their caregivers, children or teenagers on aspirin therapy, people with suppressed immune systems, people with certain chronic conditions such as diabetes, health care workers, and anyone else at high risk of flu complications.

Osteoporosis Prevention Starts Early

Osteoporosis, a condition in which the bones become porous and weak, is common in older people. As people age—and exacerbated, in women, by menopause—the cycle of bone restoration becomes disrupted. Ordinarily, the skeleton in a constant state of renovation and restoration, like a suspension bridge; some part is always adding new material and replacing worn-out material. However, for many people, the removal speeds up over time, or the replacement slows down, or both. This has no noticeable symptoms on its own, but it does contribute to the loss of height and posture seen as people age, as well as leaving the bones fragile and more prone to fracture.

This bone loss is more common in women than in men. In addition to osteoporosis related to menopause, that related to aging, which happens to people over 75, is twice as common in women than in men. Changes in the sex hormones that result from aging play a large role in the development of osteoporosis, and anything else that reduces the level of those hormones—breast cancer treatments that reduce estrogen levels, or prostate cancer treatments that have a similar effect on testosterone—can contribute to osteoporosis. Overactive thyroid, or thyroid medication to treat underactive thyroid, also increase the risk. People who take corticosteroid drugs for chronic inflammation often experience bone loss as well.

Preventing osteoporosis, for people at risk, means consulting a medical professional, particularly for people who take corticosteroids, have been treated for breast or prostate cancer, have experienced hormonal problems, or who have thyroid illness. There are some lifestyle changes that can also help ward off bone loss. A sedentary lifestyle is a risk factor for osteoporosis, and so getting exercise can help reduce the risk. Calcium and vitamin D, either in the diet or from supplements, can also prevent the condition from developing.

However, experts now say the foundation for osteoporosis in old age is laid in childhood, and so the foundation for bone health needs to be as well. While calcium and vitamin D later in life can help, they are particularly important in childhood. Many other risk factors, such as exercise and body weight, are likewise rooted in habits best developed while young.