New study possibly links cognitive and motor delays with 'flat head syndrome' in young babies

February 16, 2010

Researchers caution not to be alarmed; more study needed to determine if delays are persistent and significant

In a new study, infants averaging six months of age who exhibited positional plagiocephaly (flat head syndrome) had lower scores than typical infants in observational tests used to evaluate cognitive and motor development. Positional or deformational plagiocephaly may occur when external forces shape an infant's skull while it is still soft and malleable, such as extended time spent lying on a hard surface or in one position. This is the first controlled study to suggest that babies who have flattened areas on the back of their heads during the first year of life may be at risk for developmental delay. Led by clinical psychologist Matthew L. Speltz, PhD, from Seattle Children's Research Institute, these findings suggest that babies with plagiocephaly should be screened early in life for possible motor and cognitive delays. "Case-Control Study of Neurodevelopment in Deformational Plagiocephaly" published online on February 15 in Pediatrics.

"Developmental plagiocephaly seems to be associated with early neurodevelopmental disadvantage, which was most evident when testing motor skills," said Matthew L. Speltz, PhD, chief of outpatient psychiatric services at Seattle Children's Hospital and professor of psychiatry and behavioral sciences at the University of Washington School of Medicine. "This suggests that babies with flat head syndrome should be screened and monitored for possible cognitive and motor delays. However, it's also important to note that our study examined babies at one particular point in time, so we cannot say with certainty whether these observations continue to hold true as these infants grow older. Our future studies will re-visit this population at 18 and 36 months of age, to see whether this association persists as these infants mature."

"Statistically, there has been a dramatic rise in the diagnosis of positional plagiocephaly since the 1990's. This may be a result of multiple factors, including increased awareness and babies spending more time on their backs in strollers, car seats, infant seats, cribs and sleeping on their backs. This time period also coincides with the national Back-to-Sleep campaign designed to help protect babies against Sudden Infant Death Syndrome (SIDS), although it should be noted that a direct correlation with flat head syndrome hasn't been scientifically established," added Speltz. "For every ten babies, one or two may have at least mild plagiocephaly. Many parents and physicians have dismissed it as a cosmetic issue or one that babies will grow out of as they develop, but our study indicates that we should look deeper."

In the study, 472 babies with ages ranging from four to 12 months (average age six months) were screened for cognitive and motor development using the Bayley Scales of Infant Development III (BSID-III), a series of industry standard observational tests. These common tests observe babies for basic cognitive, language and motor skill development. During the BSID-III, trained examiners present a series of standardized test materials to the child and observe their responses to simple tasks that require problem-solving and memory, such as searching for a hidden toy, as well as the ability to imitate, vocalize, observe and respond to their environment. Infant motor skills like crawling, rolling from side to side, and being able to lift up from a tummy position are also observed and measured. Half of the babies in the study had exhibited and been diagnosed at the Seattle Children's Hospital Craniofacial Center with some level of flat head syndrome, while half were a "normal" control group.

For the study, cranial images and measurements of each baby's head shape and size were also obtained using a 12-camera, 3-D system that allows for 360o imaging of the head. The study found that those babies who exhibited some degree of flatness at the back of the head were more likely to perform worse on the BSID-III, by an average of 10 points for the motor test scale. The most significant lower scores showed in large muscle motor functions, such as rolling from back to side.

Though the findings indicated an association between flat head syndrome and developmental delay, they do not indicate a direct causal link, the researchers say. There may be a reverse correlation, if, for example, babies with pre-existing motor delays are more likely to end up with flatter heads because they may move less or remain in one stationary position for longer periods of time.

"Physicians, psychologists and parents all need to know that it remains very important for babies to continue sleeping on their backs," added Speltz. "Regardless of any suggestion of plagiocephaly or developmental delay, the safest way for babies to sleep still aligns with the Back-to-Sleep campaign's recommendations to help prevent SIDS."

Seattle Children's Research Institute

Childhood trauma and psychosis

Great academic article from 2008 that very credibly disputes the biomedical model of psychiatry. This is just a small excerpt:

From Journal of Post Graduate Medicine:

A recent review of the North American psychiatric literature over the past 40 years concluded that potential social causes of psychosis, including schizophrenia, have been neglected in favor of the advancement of genetic and biological etiologies. [30] However, Kraeplinian conceptualizations of psychotic experiences as merely the symptoms of a disordered brain have been challenged by prominent academicians such as Richard Bentall and others who question the validity and utility of schizophrenia as a conceptual and diagnostic entity, and argue that psychotic experiences lie on a continuum with “normal” functioning and suggest that contemporary conceptualizations of “schizophrenia,” “bipolar disorder,” and associated complaints should take into account the role of adverse environmental factors. [31] Furthermore, in the last ten years there has been renewed interest and a growing body of literature examining the role of social and environmental factors in the etiology of psychosis and schizophrenia. Much of this research has specifically focused on the relationship between childhood trauma, psychosis, and schizophrenia.

A number of significant reviews of the literature examining the relationship between childhood trauma, psychosis and schizophrenia have been published in the last few years. [18],[32],[33],[34] A review by Read et al . [6] summarized research studies and examined other review papers addressing the relationship between childhood trauma, psychosis and schizophrenia. This review examined studies of psychiatric inpatients and outpatients where at least 50% were diagnosed with a psychotic condition. Studies that were included were required to have used interview protocols or questionnaire measures that specified examples of abusive acts to determine abuse, therefore chart reviews were excluded. The review produced weighted averages from 51 studies and reported that the majority of female patients (69%) reported either childhood sexual abuse (CSA) (48%) or childhood physical abuse (CPA) (48%). The majority of male patients (59%) reported either CSA (28%) or CPA (50%). The authors of this review point out that these rates are likely to be underestimates as child abuse is generally under-reported [35] especially by people who are inpatients [36],[37] and men in particular. [38] The bulk of the evidence considered in this review, however, was from studies using cross-sectional designs or uncontrolled group comparisons, which the authors concede can give us useful estimates of the prevalence of childhood trauma in clinical populations, but tell us little about whether the relationship between childhood trauma and psychosis is causal. Consequently, Read and colleagues also examined data from four large-scale studies with more sophisticated methodologies which represent a more robust test of the hypothesis that childhood trauma plays a causal role in psychosis. (read much more here)

Definitely an article to keep handy for those who want academic studies that support an alternative view to the biomedical model.

FOR KIDS: Physics of running bared

Running without shoes softens the blow

By Stephen Ornes

Web edition : Monday, February 15th, 2010

To complete a recent study, a team of scientists left Boston and went halfway around the world, to the middle of Kenya. They wanted to find out more about barefoot running.

Sure, people can run barefoot anywhere. But the Rift Valley Province in Kenya has produced some of the most famous long-distance runners in history, and many of these athletes grew up not wearing shoes. With a video camera in hand, scientist Daniel Lieberman and his colleagues visited some of these runners to figure out what a difference shoes make.

It was a big difference, and not necessarily for the better. In particular, when a bare foot hits the ground, the blow is softer and the running motion smoother. This research suggests that running barefoot may have advantages over running with shoes on, though more studies are needed to determine whether or not barefoot running reduces the chance of injuries. Also, the team didn’t investigate whether there’s a difference for sprinting.

“One shouldn’t be scared of barefoot or minimal shoe running or think it odd,” Lieberman told Science News. “From an evolutionary perspective, it’s normal and, if done properly, it is very fun and comfortable. We evolved to run barefoot.”

Lieberman is an evolutionary biologist at Harvard University. An evolutionary biologist is a scientist who studies the way living creatures have changed over long periods of time. With his research, Lieberman wants to know why and how the human body works the way it does.

Previous studies have shown that when a person runs barefoot, she lands on the fronts or middles of the feet. Then the heel goes down. During this process, the weight of the body is at first on the front of the feet, then moves to the heel. Lieberman and his colleagues saw this motion firsthand in Kenya — the runners landed on the fronts of their feet.

When a person wears shoes, however, he tends to run so that his heels hit the ground first. The impact of the heel hitting the ground may be much more forceful than the impact of the front of the foot hitting the ground.

In the 1970s, shoe companies began selling running shoes that had cushioned soles. Those soles distributed the body weight through the foot and may have influenced the way people ran. Once runners started wearing these shoes, they could land on their heels and still be comfortable.

The researchers also studied barefoot runners in their laboratory in Boston. The goal was to measure the force with which a runner’s foot hits the ground. Force is calculated by multiplying the mass of an object — such as a human body — with its acceleration. By studying this force, the scientists could compare the impact of different running styles.

“A rear-foot strike is like someone hitting you on the foot with a hammer with about one and a half to three times your body weight. It would hurt without a shoe,” Lieberman told Science News. “A forefoot strike is like having no one hit you at all.”

Daniel Schmitt is an evolutionary anthropologist at Duke University. He told Science News that the new study by Lieberman and his colleagues is “really elegant and well done,” and that the finding is a clear, good example of the science behind different running styles.

Lieberman’s study explores the physics of running, which is a complex topic. Reed Ferber is a biochemist at the University of Calgary in Canada. The idea that barefoot running is better “is a massive assumption,” he told Science News. “Fundamentally, there are no studies out there that show barefoot running is less injurious.” In other words, don’t throw out those fancy running shoes just yet.

POWER WORDS (adapted from Yahoo! Kids Dictionary)

biological evolution The process of physical change in living things across generations.
biology The science of life and of living organisms, including their structure, function, growth, origin, evolution and distribution.
biochemistry The study of the chemical substances and vital processes occurring in living organisms.
force The capacity to do work or cause physical change

Methemoglobinemia presenting in a circumcised baby following application of prilocaine: a case report

Abstract (provisional)

Introduction

Local anesthesia with prilocaine has become a routine part of ambulatory circumcision procedures. Methemoglobinemia is rare but potentially lethal complication of local anesthetics.

Case presentation

We report a case of a 40 day old boy who presented with cyanosis after receiving local anesthesia with prilocaine. Methemoglobin level revealed severe methemoglobinemi (methemoglobin=44%). His cyanosis resolved after intravenous administration of methylene blue.

Conclusion

Even though the association between prilocaine use and methemoglobinemia has generally restricted prilocaine use in infants, it is still widely used in ambulatory procedures, expecially during circumcision in the neonatal period. Prilocaine should not be used in infants less than 3 months of age because the risk of methemoglobinemia and alternative local anesthetics may be considered among this age group. Furthermore general anesthesia by mask ventilation may be favored for infants less than 3 months of age instead of local anesthetics.

Sweet Tooth in Children May Be Linked to Alcoholism

By Jeanna Bryner, LiveScience Managing Editor


Most kids won't turn down a sugary treat, but it turns out some children prefer more intense sweetness than others. Those kids drawn to sweeter-than-cola drinks are also more likely to have a family history of alcoholism and depressive symptoms, a new study finds.

"We know that sweet taste is rewarding to all kids and makes them feel good," said lead researcher Julie Mennella, a developmental psychobiologist at Monell Chemical Senses Center in Philadelphia. "In addition, certain groups of children may be especially attracted to intense sweetness due to their underlying biology."

The results, however, don't mean a child who likes ultra-sweetened foods will become an alcoholic. It's just a link between sweet preference and family members with alcoholism. "At this point, we don't know whether this higher 'bliss point' for sweets is a marker for later alcohol use," Mennella said.

Either way, the link between sweets and alcohol would make sense, as both activate many of the same reward circuits in the brain, the researchers say. And since sugar can be a mood booster, depressed kids may be drawn to it to help them feel better.

How sweet?

In the study, Mennella and her colleagues had 300 children ages 5 to 12 taste five levels of table sugar in water and choose which they preferred most. The participants answered questions about depression and their mothers provided information about family alcohol use.

Nearly half of the children had a family history of alcoholism, meaning they had a parent, sibling, grandparent, aunt or uncle who had been diagnosed with alcohol dependence. About 25 percent of the kids reported depressive symptoms.

The 37 children who had both a family history of alcoholism and had depressive symptoms were most likely to prefer intense sweetness, with these children on average choosing water with 24 percent sugar, or about 14 teaspoons in a cup of water. That's more than twice the concentration of sugar in a typical soda, the researchers say.

Other children preferred the 18-percent sugar mixture on average.

Another part of the current study tested sugar's pain-reducing effects by having kids hold either water or sugar in their mouths while keeping their hand submerged in cold water. Non-depressed kids with sugar in their mouths kept their hands submerged 36 percent longer than kids tasting water. That same effect wasn't found for the depressed group of kids.

"It may be that even higher levels of sweetness are needed to make depressed children feel better," Mennella said.

Why we like sugar

The results could help scientists design strategies for getting kids to reduce their refined sugar intake, Mennella said. That could be tough since overall, kids are innately drawn to sweets more than adults.

"The liking for sweets was designed to attract us to foods that were higher in energy, like fruits," Mennella told LiveScience. And so it makes sense for children to crave sugary foods, which long ago would have been healthy items, such as fruits. "We didn't evolve in the environment that we live in now where we have all of these refined sugars," Mennella said.

But the new results suggest some kids like sweets even more than their sugar-loving pals. "The bottom line is, telling one child to cut out sweets is going to be a lot harder than telling another child," Mennella said.

The research, which is published in the journal Addiction, was funded by the National Institute on Alcohol Abuse and Alcoholism and the National Institute of Child Health and Human Development.