Houston Area Pediatric Specialists

Independent pediatric specialists aim to serve our community. We want to share news and analysis regarding our specialties and our practices.

Tuesday, August 21, 2012

Pregnancy and fish: What's safe to eat?

Nice summary on fish in pregnancy. I have not heard any parents use this excuse that they are going to the lake to catch some brain healthy Omega-3's. But, certain fish may be better catches than others. JR

Pregnancy and fish: What's safe to eat?

By Mayo Clinic staff

If you're confused about whether it's safe to eat seafood during your pregnancy, you're not alone. Understand the guidelines for pregnancy and fish.

By Mayo Clinic staff
Photo of Roger Harms, M.D.
Roger Harms, M.D.
If you're pregnant, you might feel like you need to become a nutrition expert overnight. After all, what you eat and drink — and what you avoid — influences your baby's development. Some choices are logical, such as eating plenty of fruits and vegetables and eliminating alcohol from your diet. But what about seafood? When it comes to pregnancy and fish, researchers give mixed reports.
Here, Roger Harms, M.D., a pregnancy specialist at Mayo Clinic, Rochester, Minn., and medical editor of "Mayo Clinic Guide to a Healthy Pregnancy," offers practical advice about pregnancy and fish.

What's the link between pregnancy and fish?

Seafood can be a great source of protein and iron — crucial nutrients for your baby's growth and development. In addition, the omega-3 fatty acids in many fish can promote your baby's brain development.
But some types of seafood — particularly large, predatory fish such as shark, swordfish, king mackerel and tilefish — may contain high levels of mercury. Although the mercury in seafood isn't a concern for most adults, special precautions apply if you're pregnant or planning to become pregnant. If you regularly eat fish high in mercury, the substance can accumulate in your bloodstream over time. In turn, too much mercury in your bloodstream could damage your baby's developing brain and nervous system.

How much seafood is recommended?

The Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) say pregnant women can safely eat up to 12 ounces (340 grams) of seafood a week. Similarly, the 2010 Dietary Guidelines for Americans recommend 8 to 12 ounces of seafood a week for pregnant women — or about two average meals.
Not all researchers agree with these limits, however, citing a study that noted no negative effects for women who ate more seafood than the FDA-approved guidelines.

What's safe to eat?.....

Are fish oil supplements safer than fresh or frozen fish?

While some research has shown that women who take fish oil supplements during pregnancy might improve their children's hand-eye coordination, the findings are preliminary — and other research doesn't support a link between fish oil supplements and improved cognitive or language development in children. The safety of fish oil supplements during pregnancy also has yet to be established. More studies are needed before fish oil supplements can be routinely recommended during pregnancy.

Are there other ways to get omega-3 fatty acids?

Most research on pregnancy and omega-3 fatty acids focuses on seafood or supplements. Other sources of omega-3 fatty acids — such as flaxseed oil, canola oil, soybean oil, ground flaxseed and walnuts — can be part of a healthy diet as well. However, researchers haven't yet determined whether omega-3 fatty acids from plant sources can promote fetal brain development.

What's the bottom line?

Though mercury can harm a developing baby's brain, eating average amounts of seafood containing low levels of mercury during pregnancy hasn't been shown to cause problems. And the omega-3 fatty acids in many types of fish — especially salmon and tuna — can promote healthy cognitive development. As long as you avoid fish known to be high in mercury or contaminated with pollutants, fish can be a regular part of your healthy-eating plan during pregnancy.
More below

Original Article:  http://www.mayoclinic.com/health/pregnancy-and-fish/PR00158

Tuesday, August 14, 2012

Asthma Drug May Help Kids Avoid Sleep Apnea Surgery

This is an interesting article from Web MD about an upcoming paper to be published in the journal Pediatrics.  The "small" and "preliminary" nature of this study should be emphasized.  Also, home sleep testing is mentioned here.  However, this is not an accepted test in children.  Dr. Susarla

Asthma Drug Helps Kids Avoid Sleep Apnea Surgery?

Small Study Suggests Singulair Can Improve Sleep Apnea Symptoms in Some Kids
Aug. 7, 2012 -- A new study suggests that a common asthma drug may be able to help children with sleep apnea avoid surgery.
Children with obstructive sleep apnea may be tired by day, have trouble paying attention in school, and have other behavioral problems because they are not getting enough quality sleep at night.
Surgery to remove the tonsils and adenoids is often recommended, but many parents are reluctant to subject their kids to any type of surgery.
New research in the September 2012 issue of Pediatrics suggests an allergy andasthma drug -- montelukast (Singulair, which just went generic) -- may lessen symptoms in children with non-severe apnea and potentially allow them to skip the surgery.
Sleep apnea is marked by pauses in breathing while asleep. Sleep apnea is often a result of an obstruction in the airway, with severity of children's sleep apnea linked to the size of tonsils and adenoids. These pauses can occur throughout the night and disrupt sleep.

Asthma Drug Improves Apnea Symptoms

Forty-six children with non-severe sleep apnea received the asthma drug or aplacebo for 12 weeks. The kids who received the drug showed improvements in tests measuring the degree of their sleep apnea, their sleep-related symptoms, and the size of their adenoids compared to their counterparts who didn't. There were no side effects seen among kids who took the study drug.
Study authors are quick to caution that this study is small and it's preliminary. Bigger studies following more children for longer periods of time are needed before this treatment is offered to any kids with sleep apnea.
Michael Rothschild, MD, also urges caution in interpreting the new findings. He is the director of pediatric otolaryngology at Mount Sinai Medical Center in New York City.
It's too early to recommend montelukast for the treatment of sleep apnea in kids. But, "it does make sense," he says. "The drug reduces inflammation in the nose and adenoids."
That said, longer follow-up is needed. "Let's do a big, long-term study in a bigger group of kids and follow them for six months or one year."
Until then, if you think your child has sleep apnea, the first step is to confirm this suspicion. "With kids, the risk is not stopping breathing, but more that it is disturbing their sleep," he says.
Sleep apnea in children may be measured in several ways. These include:
  • The gold standard sleep study conducted overnight in a lab
  • A home sleep study where children are hooked up to a monitor while they sleep
  • Videotaping of the child in the throes of what parents believe to be an apnea episode

Drug May Be Band-Aid, Not Cure

Parents also need to know that while no one wants their children to undergo surgery, removal of tonsils and adenoids is safe. "Parents often say 'anything but surgery,' and 99.9% of the time, they are terrified of anesthesia," Rothschild says.
Yosef Krespi, MD, is the director of the Center for Sleep Disorders at the New York Head & Neck Institute of Lenox Hill Hospital in New York City.
He says the allergy and asthma drug may be more of a Band-Aid, but is likely not a cure for sleep apnea in kids. "The follow-up is too short and the number of cases is too limited," he says.
There are often several factors that cause sleep apnea, and this only addresses one of them, he says.

Monday, August 6, 2012

Exercise-Induced Bronchospasm (Asthma) : What you need to know (Part 2)

Exercise Related Asthma - Don’t let untreated asthma impact your child or adolescent’s sports training this season.

Asthma affects 5 million children and adolescents in the United States.  It is estimated that about half of children with asthma will experience exercise-related symptoms.  Breathing difficulty with sports and exercise is one of the consequences of asthma that is poorly controlled, and it may be the first or only warning sign that there is a problem.  

The National Heart, Lung, and Blood Institute (NHLBI) has published guidelines for the management of exercise-induced asthma.  The same organization has also published guidelines for teachers and coaches which you can read here. But how do you know if your child has breathing difficulty in sports due to asthma?  Exercise problems can be attributed to other medical problems or simply deconditioning.  

The gold standard test is exercise challenge spirometry.   Usually, the child will be asked to perform a treadmill run with a lung function test known as spirometry before and after exercise. This is the only test that can replicate the conditions that can trigger an asthmatic reaction (bronchospasm) which can be measured in the office.  

We are proud to offer this service at our Memorial City location.  Ask your pediatrician today about testing if your child has problems with exercise.

Dr. Susarla

Exercise-Induced Bronchospasm (Asthma): What you need to know (Part 1)

Below is a summary from the Exercise-Induced Bronchospasm Landmark Survey, a study that evaluated exercise-related respiratory symptoms in children ages 4-17.  Dr. Susarla

Key Insights

The survey findings yield a number of important insights about asthma and exercise-induced bronchospasm in the United States: 
  • Patients with asthma have a significant physical burden of disease, which produces lower self-health ratings, activity limitations, and sick days, compared with persons without asthma.
  • Asthmatic patients with symptoms of exercise-induced bronchospasm (EIB) also have a significant emotional or psychological burden of disease as demonstrated by feeling more fearful, isolated, depressed, frustrated, and embarrassed than persons without EIB symptoms.
  • Nearly half of asthma patients report their health interferes with their ability to participate and perform well in sports, and more than a third feel they cannot keep up as well as other persons their own age in physical activities.
  • When asked what usually triggers their asthma or makes it worse, nearly a third of asthma patients volunteer “exercise” --- more than any other asthma trigger.
  • Four out of five asthma patients report experiencing symptoms after sports, exercise, play or other physical activity, but less than a quarter have been diagnosed with either exercise-induced asthma (EIA) or exercise-induced bronchospasm (EIB).
  • Less than a quarter of asthma patients with exercise-related symptoms take quick-relief medicine, like albuterol, always or most of the time prior to exercising.
  • Patients’ understanding of exercise-related symptoms and their management are different than healthcare providers, which may lead to miscommunications between physicians and patients regarding proper asthma management.
  • Results of the survey suggest that exercise-related symptoms among asthma patients may reflect uncontrolled or improperly managed asthma.
  • The problem of EIB is not limited to persons with asthma with more than a quarter of the adult cross-section reporting respiratory symptoms during or after sports, exercise, play or other physical activities, while less than one in five have been diagnosed with exercise-induced asthma or exercise-induced bronchospasm. 

Saturday, August 4, 2012

Asthma Common Among Olympic Athletes

Evidence that asthma does not prohibit competitive sports.  Dr. Susarla

Asthma Common Among Olympic Athletes

The Australian researcher suggested the conditions may be linked to the athletes' intense training, particularly those who participate in endurance sports or winter sports. The inhalation of cold air contributes to airway damage.
Airway hyper-responsiveness involves marked narrowing of the airways in response to some kind of outside trigger.
"Inhaling polluted or cold air is considered an important factor which might explain the cause in some sports, but not in all," explained study author Kenneth Fitch, of the University of Western Australia, in a university news release. "The quality of inhaled air could be harmful to the airways, but does not cause the same effect in all sports."
Fitch counted the number of athletes with asthma and airway hyper-responsiveness from the five Olympic games between 2002 and 2010. He identified the athletes by tracking the use of inhaled beta-2 agonists, an anti-asthma drug commonly used by top athletes.
In 2001, the International Olympic Committee recognized the increased use of the drug between 1996 and 2000, and issued a new rule requiring athletes to provide proof of their condition to safeguard the health of Olympic athletes, not as an anti-doping measure, according to the news release.
Fitch noted that athletes with asthma have routinely beaten their opponents. He added, however, there is no proof that treatments for the condition improved their performance. He suggested that training harder than other athletes could help explain why many athletes develop asthma or airway hyper-responsiveness as adults.
The study was published online in the British Journal of Sports Medicine.