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Video: What Pregnant Women Should Know About Pre-Eclampsia

In this brief video, NHS Midwife Suzanne Barber explains the warning signs of pre-eclampsia. Find out more about pre-eclampsia here

Editor’s Note: Video Highlights

  • Pre-eclampsia usually affects women in the 2nd half of their pregnancy.  If left untreated it can put both the mother’s and the baby’s health at risk as it could lead to your child being born prematurely or failing to grow as expected in the womb.
  • Early indication are often detected by your community midwife or GP (*family doctor) during an ante-natal (*prenatal) check. Women with pre-eclampsia have high blood pressure and protein in their urine.
  • Pre-eclampsia could come on quickly. If it does, symptoms may include:
    • Swelling: face, hands, ankles
    • Severe headaches that don’t go away
    • Visual disturbances
    • Upper abdominal pain
  • You are more at risk of pre-eclampsia if you:
    • Are overweight
    • Have had kidney disease
    • Have diabetes
    • Have high blood pressure
  • If you are diagnosed with pre-eclampsia, you will have more active antenatal care and will be monitored more closely, however if there is cause for concern, you may need to be admitted to the hospital, and it may be advised that you have your baby earlier than expected.
  • Your GP or midwife may advise you if supplements can help lower your risk of pre-eclampsia.
  • If you feel unwell and experience any of the symptoms described above, see a midwife or GP.

Editor’s Note: *clarification provided for our US readers.

 





Study: Premature Babies May Benefit from School Delay

Premature babies more likely to under perform at school, study finds,” reports The Independent. Results from a new study have prompted calls that some children should be held back a year before starting school.

Previous research has found that premature babies have worse school performance than babies born at term. A new study has investigated whether this poor performance could be due to premature babies being compared with children born at term who, even if they were born at the same time, are effectively older than they are.

In addition, children who are born prematurely may be enrolled at school a year earlier than predicted by their expected due date. For example, a premature baby born in July could start school a year earlier than if they had been born at full term in September. So they would be enrolled in school effectively a year early, leaving the child constantly struggling to keep up.

The researchers looked at performance on “key stage one” tests – a UK test of reading, writing and maths skills. They also looked at whether children were judged as having special educational needs.

The researchers found that children born premature are at greater risk of having a low key stage one score, and of having special educational needs compared with children born at full term.

However, the risk was greatly reduced for preterm children who, if they had been born on their expected date of delivery, would still have been in the same school year as their actual birth date put them in.

While school performance for children born preterm may improve by delaying entry to school, the social implications of being perceived to be “held back” (to be in a school year with younger children) could have an adverse effect on the child. As the researchers conclude “whether a policy of holding infants born prematurely back to their corrected school year would have a beneficial impact is as yet unknown”.

Premature birth – reducing the risk

Premature births can happen in any pregnancy, whatever the general health and lifestyle of the pregnant woman. However, there are steps you can take to reduce the risk of having a premature birth, including:

  • Avoiding potentially harmful substances such as alcohol, tobacco and drugs
  • Trying to achieve or maintain a healthy weight
  • Eating a healthy diet

For more information about health and wellbeing in pregnancy, visit the NHS Choices Pregnancy and baby guide.

Where did the story come from?

The study was carried out by researchers from the Neonatal Unit at North Bristol NHS Trust and the University of Bristol. No source of funding was reported.

The study was published in the peer-reviewed journal PLOS One. PLOS One is an open-access journal, which means that the article is available free of charge to read online or download.

The results of the study were well covered by the UK media. All three newspapers who reported on the study – The Independent, The Daily Telegraph and the Daily Mail – provide relevant commentary from independent childcare experts.

What kind of research was this?

This was a cohort study. Previous research has found that preterm babies have worse school performance than term babies. This study aimed to determine if some of this effect was due to preterm children being enrolled in school a year earlier than they would have been if they had been born at their expected due date. In the UK all children are offered a school placement based on their actual date of birth, rather than their expected due date.

To do this, they compared school performance in children born preterm who would have attended school in the same year if their expected date of delivery had been used rather than their actual date of delivery, to the school performance in children born at term.

A cohort study is the ideal study design to address this question.

What did the research involve?

The researchers analysed data from 11,990 children born in the Bristol area between April 1991 and December 1992 who were participating in the Avon Longitudinal Study of Parents and Children (ALSPAC) – an ongoing cohort study.

Data on the gestational age at birth was extracted from clinical notes. The study included infants that were born between 23 and 42 weeks of gestation.

School performance was assessed using the results of key stage one (KS1) tests, which all children in mainstream education sit at the end of year two. In addition, teachers were sent a questionnaire that asked whether children had ever been recognised as having special educational needs.

The two primary outcomes were a low KS1 score (below 2, the expected standard in the “three Rs” of reading, writing and arithmetic), or having teacher-reported special educational needs.

The researchers looked to see if children who had been born preterm were at greater risk of low KS1 scores or having special educational needs, and whether this was due to them being placed in school a year earlier than if they had been born at term. To do this the researchers performed three analyses:

  • One where each preterm infant was matched with up to 10 term infants based on their date of birth, and the outcomes for term and preterm infants compared
  • One where each preterm infant was matched with 10 term infants based on their expected date of delivery, and the outcomes for term and preterm infants compared
  • One where each preterm infant was matched to term infants based on their expected date of delivery and year of school attendance, and the outcomes for term and preterm infants compared

In this final analysis, the researchers compared the risk of low KS1 scores and special education needs only in infants who would still have been in the same school year if they had been born at their expected date of delivery rather than their actual date of delivery.

The researchers adjusted their results for a range of factors (confounders) that could influence academic performance. These included:

  • Social factors (maternal age, socioeconomic group, education, car ownership, housing, crowding index [the number of household members per room] and ethnicity)
  • Antenatal factors (the number of times the mother had previously given birth, and gender, weight, length and head circumference at birth of the infant)
  • Factors during labour (mode of delivery, maternal high blood pressure and fever)

What were the basic results?

The study included 722 children who were born prematurely or “preterm” (at less than 37 weeks) and 11,268 children who were born at term (between 37 and 42 weeks).

Preterm infants were statistically more likely to have a low KS1 score and to receive special educational needs support.

Infants who were placed in the correct school year for their expected delivery date had higher KS1 scores than those children whose actual date of birth had put them in a different school year than their expected delivery date would have.

In children who had been born at full term, average KS1 scores were highest in the children oldest at the time of the test – i.e. children born in September. Average scores gradually decreased as the children entering the year were younger, with children born in August obtaining the lowest mean KS1 scores.

A similar pattern was seen for preterm infants, although the lowest mean KS1 scores were from children born in June.

Children born preterm were at higher risk of low KS1 score and having special educational needs when children were matched on the basis of date of birth; to adjust for the fact that, on average, the oldest children did the best on the test (odds ratio (OR) for low KS1 score 1.57, 95% confidence interval (CI) 1.25 to 1.97; OR for special educational needs 1.57, 95% CI 1.19 to 2.07).

Children born preterm were at higher risk of low KS1 score and having special educational needs when children were matched on the basis of expected date of delivery rather than gestational age (to adjust for the fact that children born preterm are actually younger than their date of birth would suggest). The OR for low KS1 score was 1.53, 95% CI 1.21 to 1.94; the OR for special educational needs was 1.59, 95% CI 1.20 to 2.11.

However, children born preterm were not at significantly higher risk of low KS1 score or of having special educational needs when outcomes were compared only for children attending school in the correct year for their expected date of delivery, and children were matched based on their expected date of delivery (OR for low KS1 score 1.25, 95% CI 0.98 to 1.60; OR for special educational needs 1.13, 95% CI 0.81 to 1.56).

How did the researchers interpret the results?

The researchers concluded that “this study provides evidence that the school year placement and assessment of ex-preterm infants based on their actual birthday (rather than their expected date of delivery) may increase their risk of learning difficulties with corresponding school failure”.

Conclusion

In the UK, all children are offered a school placement based on their actual date of birth, rather than their expected date of birth. This study has found evidence from a large UK cohort that children born preterm may benefit from school entry based on their expected date of delivery rather than their actual birth date.

The study found that children born preterm are at greater risk of having a low key stage one score, and of having special educational needs compared with children born at full term.

However, there was no significant increase in risk among preterm children who would still have attended the same school year even if they had been born on their expected date of delivery.

This arguably suggests that admission policies to schools should be based on a child’s expected date of delivery rather than actual birth date. However, as the researchers rightly point out, the issue of whether an older child would interact well with children who could be, or we perceived to be, younger than them also has to be considered.

As the researchers conclude: “whether a policy of holding infants born prematurely back to their corrected school year would have a beneficial impact is as yet unknown”.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.

Summary

“Premature babies more likely to underperform at school, study finds,” The Independent reports. Results from a new study have prompted calls that some children should be placed back a year before starting school.

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Video: How to Introduce Your Child to Sleeping in a Bed

In this brief video, NHS Health Visitor, Sara, discusses how to approach moving your young child from a cot (*crib) to a bed and gives some tips for success.

Editor’s Note: Video Highlights

  • child-moving-to-a-bedThere are no hard-and-fast rules for when to move your baby from a cot (*crib) to a bed – do it when it feels comfortable for your child and for you
  • From 18 months, you might find that your child is too big for a cot or is trying to climb out – that’s the time to move them into a bed
  • For some children, moving from a cot to a bed is really exciting and they accept it really well
  • For other children, they might feel a bit stressed about the change – so you might need to choose a calm time in their life
    • Challenging times for moving from a cot to a bed can be if you’re moving house, if you’ve gone back to work or if your child is not feeling well
  • You may need to move your child to a bed if you have another baby on the way – if so, do it about six to eight weeks before your new baby is born, to help keep your child from being unsettled with too much change
  • Once sleeping in a bed, your child might get up in the night and wander around, so be sure to childproof their room
    • Put a stair gate across the door
    • Check their room for any electrical appliances or wires they could trip over, any small toys or objects they can get hold of or any cord blinds that they could get tangled in
    • You might also want to put barrier next to the bed or put cushions on the floor in case they fall out
  • If your child doesn’t like the bed initially and they want to protest, just stay calm, reassure them, give them a cuddle, but put them back in the bed
    • You might find that you have to do it a few times, but if you’re consistent, they’ll soon get used to being in the bed
  • When your child has slept in the bed, or had some naps in the bed, praise them because it can make a big difference to their confidence and they’ll feel much more willing to sleep in the bed if you praise them for what they’ve done

Editor’s Note: *clarification provided for our US readers.

 





When and How to Treat a Fever: a Pediatrician’s Perspective

I have posted in the past about fever and many of the myths surrounding it (Kids Will Get Sick: 5 Facts a Pediatrician Wants You To Know).  In this post I would like to deal with the causes, nature of fever, benefits of fever, and some “treatments”.  It is one of the most common reasons people bring their children to the Emergency room and probably among the least significant reasons for doing so.

Fever is a symptom of an illness such as cough, runny nose, headache, and many others and, except for the discomfort of the associated symptoms (chills, achiness, drowsiness, etc.) fever, in and of itself, does not need to be treated.  As far as what is the definition of fever, it depends on the age of your child or infant. Just about any fever in an infant less than 3 months of age is considered to be significant for the purpose of evaluation.  As your baby/child gets older the level of fever at which the concern rises does so with the height of the fever and the associated symptoms.  Beyond the immediate newborn period (up to age 3 months) fever (or better termed higher than normal body temperature) is generally considered to be over 100.4 to 100.5 Fahrenheit.

Fever is part of the immune reaction that your body goes through to identify the offending agent and muster the resources to fight off that agent.  Some studies have shown that the presence of fever helps your body fight off the disease in a more rapid and efficient way.  As such, it is easy to see that in fighting off an illness, the reduction of that fever for its own sake is not necessarily the best thing to do.  As I mentioned in my last post about fever, if your child is very uncomfortable due to the presence of fever, it certainly is reasonable to give a medicine such as Tylenol or Advil, but not just because the fever is there.

In an effort to reduce fever by worried parents many methods have been tried; such as placing a child in a cold bath or sponging with cold water, even to go as far as placing ice packs in supposedly strategic places.  This would seem logical at first blush but in fact, human beings have a very good method of warming a cold body, and that is shivering, wherein the muscles go into a hypermetabolic state producing heat by metabolic processes.  It is possible to place someone with a fever in a cold bath and have him or her come out with a higher temperature than before the bath.  So the reasonable approach to comfortably lower a fever is to undress a child with fever but not enough to stimulate chills or shivering, place your child in a warm (skin temperature) bath of only a few inches of water and sponge off your child frequently allowing for natural evaporative processes to cool the skin.  Offer your child plenty of cool fluids that will do some cooling from within as well as keeping him/her well hydrated- fever will cause extra fluid loss through sweating and the hypermetabolic state.  Do not wrap your child in blankets just to “sweat the fever out” as doing this may also inadvertently raise fever, and increase fluid loss and discomfort- certainly covering the child enough to relieve chills and shivering is appropriate for comfort.

In trying to determine whether someone who runs a lower than “normal” natural body temperature is running a fever, just use the reading you get with the thermometer as the difference between a normal temperature and one that “runs low” is very small and would not be significant medically.  Furthermore body temperatures vary throughout the 24 hour day in the same person- so when that “normally low” body temperature was taken becomes important.

So you can almost expect fever to accompany any illness of an infectious nature whether mild or severe.  Keep calm, it is not the fever that is important, but the appearance, behavior and the presence of certain other symptoms that your Doctor with be most interested in when you call his office.

How to Boost Your Child’s Bones for Lifelong Health

Children’s bones keep growing throughout childhood. They grow fastest of all very early in life and when children go through puberty.

The bones keep getting denser until they reach what’s known as “peak bone mass”. This usually happens between the ages of 18 and 25.

boost-your-childs-bone-healthThe denser your child’s bones are at the time of peak bone mass, the greater their reserves of bone to protect against the fragile bone disease osteoporosis later in life.

“The reserve of bone you establish during childhood and the teenage years is with you through early adulthood,” explains Dr Paul Arundel, a consultant in paediatric metabolic bone disease at Sheffield Children’s Hospital. “We all start to lose bone mass later in life. If you are starting from a low baseline you are more likely to develop osteoporosis sooner.”

The good news is that you can protect your child’s bone health with some simple lifestyle measures.

Your Child’s Bone-friendly Diet

Building strong bones in childhood requires a range of vitamins and minerals. A healthy, balanced diet will provide this. That means a diet that includes:

  • fruit and vegetables – at least five portions every day (but no more than one 150ml – *about 5 oz – glass of fruit juice)
  • carbohydrates – such as potatoes, pasta, rice and bread (preferably wholegrain)
  • protein – such as meat, fish, eggs, beans, nuts and seeds
  • dairy products – such as milk, cheese and yoghurts

There are a couple of nutrients that are particularly important for building strong healthy bones.

Calcium for Healthy Bones

Our bodies contain about 1kg (*about 2.2 lbs) of calcium. About 99% of this is found in our bones and teeth – it’s what makes them strong and hard. Most of this calcium is laid down during childhood and the teenage years.

Calcium is particularly vital during puberty when the bones grow quicker than at any other time. Puberty takes place over a number of years, typically sometime between 11 to 15 for girls and 12 to 16 for boys.

The recommended calcium intake for children and young people aged from 11 to 18 is 800-1,000mg compared with 700mg for adults. But research shows that, on average, children and young people in this age group don’t get enough.

“Teens need more calcium because they’re growing,” says Dr Arundel. “People don’t think about bone health in teenagers as much as they do with toddlers, but teenagers are growing a lot more.”

Foods that contain lots of calcium include dairy foods such as milk, cheese and yoghurt, but also tinned sardines (with the bones in), green, leafy vegetables (but not spinach), peas, dried figs, nuts, seeds and anything that’s fortified with calcium, including some soya milks.

Vitamin D for Kids’ Bone Health

Vitamin D is important for bones because it helps our bodies to absorb calcium.

Our main source of vitamin D is sunlight. Vitamin D is made by our skin when it’s exposed to sunlight during the summer months (late March/April to the end of September).

There are only a few foods that are a good source of vitamin D. These include oily fish, eggs and foods that have been fortified with vitamin D, such as fat spreads and some breakfast cereals. Read Food for strong bones.

To ensure they get enough vitamin D, the following groups should take daily vitamin D supplements, to make sure they get enough (*US recommendations are similar – click here):

  • All babies from birth to one year of age (including breastfed babies and formula fed babies who have less than 500ml a day of infant formula)
  • All children aged one to four years old

Everyone over the age of five years is advised to consider taking a daily supplement containing 10 micrograms (mcg) of vitamin D.

But most people aged five years and above will probably get enough vitamin D from sunlight in the summer (late March/early April to the end of September), so you might choose not to take a vitamin D supplement during these months.

It’s important never to let your child’s skin go red or start to burn. Babies under six months should never go in direct sunlight. Find out how to get vitamin D from sunlight safely.

Find out more about who should take vitamin D supplements and how much to take.

If you receive benefits, you may be eligible for free Healthy Start vitamins, which contain vitamin D. Your health visitor can tell you more, or you can visit the Healthy Start website.

Bone-strengthening Exercises for Children

Daily physical activity is important for children’s health and development, including their bone health.

Try not to let your child be sedentary for long periods. You can do this by reducing the amount of time they spend sitting down, for example, watching TV or playing video games.

Children under five who aren’t yet walking should be encouraged to play actively on the floor. Children who can walk on their own should be physically active daily for at least 180 minutes (three hours) spread throughout the day. This should include some bone-strengthening activities, such as climbing and jumping.

Children aged five to 18 need at least 60 minutes (one hour) of physical activity every day, which should include moderate-intensity activity, such as cycling and playground games.

To strengthen muscles and bones, vigorous-intensity activities should be included at least three times a week. This could be swinging on playground equipment, sports such as gymnastics or tennis, or hopping and skipping.

See 10 ways to get active with your kids.

Eating Disorders and Bone Health

Eating disorders affect people of all ages, both male and female. But girls and women are more likely to be affected and anorexia most commonly develops in the teenage years.

The bones are still growing and strengthening at this time and eating disorders like anorexia can affect their development. Low body weight can lower oestrogen levels, which may reduce bone density. Poor nutrition and reduced muscle strength caused by eating disorders can also lower bone density.

If your teenage child has anorexia or another eating disorder, it’s important to seek medical advice about their bone health.

Editor’s Note: *clarification provided for our US readers.





Study: Can Music Help Premature Babies Sleep and Feed?

music-and-premature-babies“Playing music to premature babies ‘helps them sleep and improves their breathing’,” is the headline in the Daily Mail about research into the effects of ‘music therapy’ on premature babies.

While positive effects were found, it is still unclear whether this will lead to tangible health improvements.

The researchers in this study speculate that being born premature could be traumatic (from an acoustic perspective) for two reasons:

  • The baby is prematurely separated from the sound of the mother’s heartbeat and the sounds they were accustomed to in the womb
  • The baby is ‘plunged’ into the noisy environment of a neo-natal intensive care unit

Researchers wanted to see whether exposing premature babies to more comforting sounds could help compensate for these proposed sources of trauma.

They investigated three types of live music therapy, administered with the help of a certified music therapist:

  • A lullaby or any other song chosen by the parent that was modified to be like a lullaby, preferably sung by a parent
  • An instrument designed to replicate womb sounds
  • An instrument that sounded like a heartbeat

The researchers found that the therapies were associated with slowing of infants’ heartbeats, calmer breathing, and improved feeding and sleep patterns. The therapies were also associated with decreased stress levels in the parents.

It is unclear whether music therapy does improve premature babies’ health outcomes. For example, if infants receiving music therapy are able to leave hospital earlier or have better long-term health outcomes.

Where did the story come from?

The study was carried out by researchers from the Beth Israel Medical Centre, New York and was funded by the Heather on Earth Music Foundation, a non-profit organisation that provides funding for music therapy programmes in children’s hospitals.

The study was published in the peer-reviewed journal Pediatrics. This article was open access, meaning that it can be accessed for free in full from the journal’s website.

This research was well-covered by the Daily Mail. The paper also contains an aside (presumably included in an accompanying press release) that one parent chose to sing a ‘lullabied’ version of Marvin Gaye’s soul classic ‘I Heard It Through the Grapevine’ and another chose 70’s funk standard ‘Pick up the Pieces’ by Average White Band.

What kind of research was this?

This was a randomised crossover trial that aimed to determine whether three different live music interventions in premature infants could affect:

  • Physiological functions, such as heart and respiratory rates, oxygen saturation levels and activity levels
  • Developmental function such as sleep patterns, feeding behaviour and weight gain

The three interventions administered with the help of a certified music therapist were:

  • A lullaby, either Twinkle, Twinkle Little Star or any other song chosen by the parent which was modified to be like a lullaby, preferably sung by a parent
  • An ‘ocean disc’ musical instrument, which is a round disc containing metal beads that aims to replicate womb sounds
  • A ‘gato box’, a 2- or 4-tone wooden box or drum that is played with the fingers to provide a rhythm in a manner that simulates the heartbeat sound that the baby would hear in the womb

The ocean disc and the gato box were played live and were coordinated to the infant’s breath rate. All infants received each of the three possible treatments (lullaby, gato box, ocean disc) as well as a control where no sound stimulation was given.

A randomised crossover trial is similar to a randomised control trial, but after a participant has received one treatment they are swapped over to another treatment arm, meaning that all participants received all three treatments and the control.

The trial design does have the disadvantage that the benefits obtained from one treatment might still be present when a second treatment is tested.

What did the research involve?

The researchers recruited 272 premature infants aged at least 32 weeks old with respiratory distress syndrome, clinical sepsis and/or small size for gestational age in neonatal intensive care units.

The infants received each of the three possible treatments (lullaby, gato box or ocean disc) or no explicit sound stimulation (to act as a control).

Each treatment was given twice during the two-week trial (three treatments per week). The day each treatment was given and the time of day (morning or afternoon) was randomised. If the infant received an intervention in the morning, the control was given in the afternoon and vice versa. The interventions were delivered by music therapists in conjunction with parents.

Heart rate, oxygen saturation, respiratory rate and activity level were measured at one-minute intervals during the 10-minute phase before the intervention, the 10-minute phase during, and the 10-minute phase after the intervention.

The researchers also analysed the infants’ vital signs, feeding behaviours, and sleep patterns daily during the two-week period.

In addition, self-perceived stress levels in parents of infants in neonatal intensive care were assessed before and after the two-week trial.

What were the basic results?

Activity Level

The percentage of ‘quiet-alert time’ (one of several states of alertness ascribed to newborns) increased during a lullaby. After the lullaby, it decreased.

Heart Rate

All three interventions showed a significant effect over time (before, during, after) on heart rate. Heart rate decreased the most during the lullaby and gato box interventions, and after the ocean disc treatment.

Respiratory Rate

The ocean disc also decreased the number of inspirations per minute during and after the treatment.

Developmental Behaviours

Use of the ocean disc was associated with increased ‘positive sleep patterns’ and ‘sucking pattern behaviour’ increased after the gato box treatment.

Parental Stress

The music interventions were also associated with a decrease in parents’ perception of stress.

How did the researchers interpret the results?

The researchers conclude that the live sounds and lullabies applied by a certified music therapist can influence cardiac and respiratory function, may improve feeding behaviours and sucking patterns, and may increase prolonged periods of quiet-alert states. These interventions also decrease the stress felt by parents of premature infants.

Conclusion

This research has found that live music therapies may slow infants’ heartbeats, calm their breathing, improve sucking behaviour important for feeding, improve sleep patterns and promote states of quiet alertness.

Different interventions led to different patterns of improvement, but all three types of musical therapy appeared to have a positive effect on the infant. The therapies also seemed to help the parents of premature infants feel less stressed.

Although this research is interesting, it is still unclear whether music therapy can lead to tangible health improvements, for example, the researchers did not measure whether infants receiving music therapy were able to leave hospital earlier or had better long-term health outcomes.

There are also practical considerations in that access to musical therapists is likely to be limited.

Despite these limitations, the study seems to provide a degree of evidence that the deep-seated human instinct to sing lullabies to your baby does them good.

For more information, read Getting your baby to sleep

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.

Summary

“Playing music to premature babies ‘helps them sleep and improves their breathing'” is the headline in the Daily Mail about research into the effects of ‘music therapy’ on premature babies. While positive effects were found, it is still unclear.

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